Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | D0060600 | MD |
N | 208600000X | Surgeon | D0060600 | MD |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | D0060600 | MD |
NPI | 1114966033 |
---|---|
Provider Name | Dr. Lynne A Skaryak |
First Address | Cape Girardeau, MO 63701-4556 |
Second Address | Cape Girardeau, MO 63701-4556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
402649700 | (05) | MD |
CA8374 | R/R MEDICARE GROUP # (01) | MD |
H01210 | (02) | MD |
P00056017 | R/R MEDICARE PROVIDER # (01) | MD |