Healthcare Provider Details

I. General information

NPI: 1033672910
Provider Name (Legal Business Name): MATTHEW SKINNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SPRING HILL AVE STE 301
MOBILE AL
36604-1409
US

IV. Provider business mailing address

1720 SPRING HILL AVE STE 301
MOBILE AL
36604-1409
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-2663
  • Fax: 251-435-1098
Mailing address:
  • Phone: 251-435-2663
  • Fax: 251-435-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number51167
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: