Healthcare Provider Details

I. General information

NPI: 1578555231
Provider Name (Legal Business Name): PAUL SKINNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

425 LEWIS HARGETT CIR SUITE 204
LEXINGTON KY
40503-3590
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-1100
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02414
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: