Healthcare Provider Details

I. General information

NPI: 1336137991
Provider Name (Legal Business Name): RAQUEL SKIDMORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAQUEL SKIDMORE MD

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 FOREST PARK CIR
PANAMA CITY FL
32405-4920
US

IV. Provider business mailing address

219 FOREST PARK CIRCLE
PANAMA CITY FL
32405
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-9418
  • Fax: 850-215-9419
Mailing address:
  • Phone: 850-215-9418
  • Fax: 850-215-9419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number14439
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberACN244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: