NPIMap

Organization Active NPI

Associate in Dermatology and Dermatopathology PLLC

  • Dermatopathology Physician
  • Louisville, KY
National Provider Identifier
1689927576
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
13257 Issued in KY
Legal business name
ASSOCIATE IN DERMATOLOGY AND DERMATOPATHOLOGY PLLC
Practice address
1700 Old Bluegrass Ave Ste 200
Louisville, KY 40215-1174
Phone
(502) 361-3909
Fax
(502) 361-9229
NPI assigned
Oct 17, 2012
Last updated
Apr 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lafayette G Owen, MD
Title
Owner
Phone
(812) 218-8927

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0900X 13257 KY Primary

Addresses

Primary practice location

1700 Old Bluegrass Ave Ste 200
Louisville, KY 40215-1174

Mailing address

1700 Old Bluegrass Ave Ste 200
Louisville, KY 40215-1174
Phone (502) 361-3909

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1689927576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 OLD BLUEGRASS AVE STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151174",
            "telephone_number": "502-361-3909",
            "fax_number": "502-361-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 OLD BLUEGRASS AVE STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151174",
            "telephone_number": "502-361-3909",
            "fax_number": "502-361-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATE IN DERMATOLOGY AND DERMATOPATHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "LAFAYETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-218-8927",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "KY",
            "license": "13257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.