Healthcare Provider Details

I. General information

NPI: 1902281025
Provider Name (Legal Business Name): JIBRIL DIXON SKADEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 E PLANT ST STE 100
WINTER GARDEN FL
34787-3160
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 407-287-6363
  • Fax: 844-388-6186
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME133396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: