Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 18046 | AL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 18046 | AL |
N | 207ND0900X | Dermatopathologist | 18046 | AL |
NPI | 1295727048 |
---|---|
Provider Name | Steven Mark Skinner |
First Address | Cullman, AL 35058-0795 |
Second Address | Cullman, AL 35058-0795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000031800 | (05) | AL |
051031800 | BLUE CROSS BLUE SHIELD (01) | |
070009500 | MEDICARE - RAILROAD (01) | |
F25238 | (02) | AL |