SAMUEL J PRUDEN II (NPI# 1871593996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871593996 |
| Entity Type | Individual |
| Full Name | SAMUEL J PRUDEN II |
| Credential | MD |
| Practice Address |
989 Governors Ln Ste 220 Lexington KY 40513-1175 |
| Practice Telephone | 8592967546 |
| Practice Fax Number | 8597210829 |
| Mailing Telephone | 8592967546 |
| Mailing Fax Number | 8597210829 |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2020-01-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
34192 | KY | Allopathic & Osteopathic Physicians |
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
34192 | KY | Allopathic & Osteopathic Physicians |
| N | 207Y00000X | Otolaryngology | 34192 | KY | Allopathic & Osteopathic Physicians |
| N | 208200000X | Plastic Surgery | 34192 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | ANTHEM BCBS | 000000823142 | 01 |
| KY | 64051196 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 448 Lewis Hargett Cir, Ste. 240, Lexington, KY 405033594 | 8592260206 | 8592260207 |
| Street Address |
989 GOVERNORS LN STE 220 |
| City | LEXINGTON |
| State | KY |
| Zip Code | 40513-1175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942852157 | Anna Gayle Scott | Physician Assistant | 989 Governors Ln Ste 220, Lexington, KY 40513-1175 | 2019-07-09 |
| 1255851200 | Regional Dermatology Pllc | Dermatology | 989 Governors Ln Ste 220, Lexington, KY 40513-1175 | 2017-06-21 |
| 1124047717 | John W. Richard | Family Medicine | 989 Governors Ln Ste 220, Lexington, KY 40513-1175 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861991531 | Angela C Dehart, Lcsw | Social Worker | 1040 Monarch St Ste 110, Lexington, KY 40513 | 2018-02-07 |
| 1831623313 | Dustin Mayrand | Student in an Organized Health Care Education/Training Program | 3141 Beaumont Centre Cir Ste 300, Lexington, KY 40513 | 2017-04-12 |
| 1992253249 | Apollo Laboratory Science and Technology Services | Clinical Medical Laboratory | 3191 Beaumont Centre Cir Ste 150, Lexington, KY 40513 | 2016-09-15 |
| 1457751174 | Kentucky One Health | Community/Behavioral Health | 3251 Beaumont Circle, Saint Joseph Healthy Lifestyle Center, Lexington, KY 40513 | 2014-08-29 |
| 1063777316 | Baptist Physicians Lexington, Inc | Internal Medicine | 3084 Lakecrest Circle, Suite 100, Lexington, KY 40513 | 2012-07-11 |
| 1346524329 | Katherina Terhune | Social Worker | 1000 Monarch Street, #250, Lexington, KY 40513 | 2011-10-07 |
| 1619206539 | Beamont Chiropractic LLC | Chiropractor | 3160 Beaumont Circle, Suite 130, Lexington, KY 40513 | 2009-12-24 |
| 1659604197 | Thomas Fordham Brewer | Preventive Medicine | 3234 Beacon St., Lexington, KY 40513 | 2009-09-16 |
| 1033368931 | Katy M Breeze | Pharmacist | #2573 Palomar Centre Dr, Rite Aid Pharmacy, Lexington, KY 40513 | 2008-09-16 |
| 1356485890 | Muscle & Rom Testing LLC | Specialist | 3726 Military Pike, Lexington, KY 40513 | 2007-02-17 |
| Find all providers in zip 40513 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457355174 | John L Buker | Dermatology | 3475 Richmond Rd, Ste 200, Lexington, KY 40509-2500 | 2005-06-10 |
| 1003133901 | Joseph Allen Blackmon | Dermatology | 2424 Harrodsburg Rd Ste 200, Lexington, KY 40503 | 2010-05-01 |
| 1609924018 | Buker Office Based Surgery, Pllc | Dermatology | 3475 Richmond Rd, Suite 200, Lexington, KY 40509-2500 | 2007-01-08 |
| 1992701320 | Dermatology Consultants, Psc | Dermatology | 2424 Harrodsburg Rd, Suite 200, Lexington, KY 40503-2106 | 2005-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821435074 | Robert Louis Skaggs II | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2013-05-29 |
| 1326203142 | Dermatology of Southern Kentucky Pllc | Dermatology | 85 Tower Cir, Somerset, KY 42503-3476 | 2008-07-21 |
| 1740315589 | Jack Foster Ditty Jr. | Dermatology | 100 Saint Christopher Dr, Ashland, KY 41101-7016 | 2007-02-22 |
| 1902302987 | Kentucky Skin Cancer Center Pllc | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2018-03-30 |
| 1477922672 | Forefront Dermatology, S.c. | Dermatology | 2333 Ring Rd, Elizabethtown, KY 42701 | 2015-09-17 |
| 1861897217 | Forefront Dermatology, S.c. | Dermatology | 501 S 2nd St, Louisville, KY 40202 | 2014-10-28 |
| 1932132768 | Dermatology and Skin Cancer Specialists, Psc | Dermatology | 2200 E Parrish Ave, Bldg E Suite 205, Owensboro, KY 42303-1449 | 2006-07-07 |
| 1114969201 | Johnathon Curtis Edge | Dermatology | 2200 E Parrish Ave, Bldg E Suite 205, Owensboro, KY 42303-1449 | 2006-06-12 |
| 1134112808 | Scott Andrew Neltner | Dermatology | 2701 Chancellor Dr, Crestview Hills, KY 41017-5479 | 2005-08-26 |
Please comment or provide details below to improve the information on SAMUEL J PRUDEN II.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.