Healthcare Provider Details

I. General information

NPI: 1730388992
Provider Name (Legal Business Name): KENT EDWARD SKOGERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 LAUREL AVE
LAKE ISABELLA CA
93240
US

IV. Provider business mailing address

8045 LIST COUNTRY RD
CARSON CITY NV
89703-9528
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-2681
  • Fax:
Mailing address:
  • Phone: 775-885-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA39437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: