Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 0202004874 | VA |
NPI | 1124063730 |
---|---|
Provider Name | Mr. Jon Roger Skaggs |
First Address | Ashland, KY 41102-6625 |
Second Address | Huntington, WV 25704-9300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/07/2007 |