MEDICARE: RAYMOND RALPH SKINNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	SC19710	SC

General Provider Information

NPI Number	:	1437198876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND RALPH SKINNER M.D.

Provider Business Mailing Address
First Line	:	673 BOGEYVILLE RD
Second Line	:
City	:	RIDGE SPRING
State	:	SC
Zip	:	29129-9772
Country	:	US
Telephone Number	:	803-649-3122
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E COLUMBIA AVE
Second Line	:
City	:	BATESBURG-LEESVILLE
State	:	SC
Zip	:	29006-2130
Country	:	US
Telephone Number	:	803-532-3857
Fax Number	:	903-532-3870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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