Healthcare Provider Details

I. General information

NPI: 1104289818
Provider Name (Legal Business Name): MATTHEW SKOVGARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

1322 ARABELLA ST APT B
NEW ORLEANS LA
70115-4200
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-8890
  • Fax:
Mailing address:
  • Phone: 678-779-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA203768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: