Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | DO0000002977 | TN |
N | 207ND0101X | MOHS-Micrographic Surgeon | DO0000002977 | TN |
NPI | 1407143480 |
---|---|
Provider Name | David Ryan Skinner |
First Address | Maryville, TN 37801-4703 |
Second Address | Alcoa, TN 37701-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q022112 | (05) | TN |