Healthcare Provider Details

I. General information

NPI: 1184286510
Provider Name (Legal Business Name): GABRIEL VINCENT SKIBA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/14/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 N. BUSINESS ROUTE 5
CAMDENTON MO
65020-6502
US

IV. Provider business mailing address

304 W WASHINGTON AVE
RICHLAND MO
65556-7101
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax:
Mailing address:
  • Phone: 877-406-2662
  • Fax: 573-346-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021038267
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: