Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 171 | AL |
NPI | 1265543524 |
---|---|
Provider Name | Dr. Gerard A. Skaziak |
First Address | Guntersville, AL 35976-0404 |
Second Address | Guntersville, AL 35976-1840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000078853 (5738) | (05) | AL |
00171 | CONTROLLED SUBSTANCE LICE (01) | AL |
1205 | LVFFC STATE LICENSE (01) | AL |
1253800001 | DMERC # (01) | |
1265543524 | NPI INDIVIDUAL # (01) | |
1306045588 | GROUP NPI # (01) | |
171 | AL STATE LICENSE (01) | AL |
2710035 | UNITED HEALTH CARE (01) | AL |
38652 | HEALTH PARTNERS (01) | AL |
480024856 | RAILROAD MEDICARE (01) | AL |
631189931 | OLD TAX ID # (01) | |
721400816 | NEW TAX ID # (01) | |
9861 | GUNTERSVILLE CITY LICENSE (01) | AL |
BS4209878 | DEA (01) | AL |
U64878 | (02) | AL |