Healthcare Provider Details

I. General information

NPI: 1558327387
Provider Name (Legal Business Name): GRAYDON W SKEOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E ALVARADO ST
FALLBROOK CA
92028
US

IV. Provider business mailing address

43525 CALLE DE VELARDO
TEMECULA CA
92592-2628
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-1191
  • Fax:
Mailing address:
  • Phone: 818-509-2222
  • Fax: 818-761-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG72841
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG72841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: