Healthcare Provider Details

I. General information

NPI: 1780171801
Provider Name (Legal Business Name): ADAM PAUL SKIPPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 01/11/2024
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7273 VANDERBILT BEACH RD STE 33
NAPLES FL
34119-1479
US

IV. Provider business mailing address

3451 PINE RIDGE RD BLDG 601
NAPLES FL
34109-3922
US

V. Phone/Fax

Practice location:
  • Phone: 239-449-3072
  • Fax: 877-334-1886
Mailing address:
  • Phone: 239-449-3072
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: