Healthcare Provider Details

I. General information

NPI: 1780909002
Provider Name (Legal Business Name): NICOLAS J SKORDAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGCS/SGCOO 101 BODIN CIR
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

60 MDG/SGCS/SGCOO 101 BODIN CIR
TRAVIS AFB CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number26624
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA153734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: