| NPI | 1013069301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. MARK JACKSON Partner 502-583-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2014-01-17 |