Healthcare Provider Details

I. General information

NPI: 1699472282
Provider Name (Legal Business Name): RYAN GREGORY SKINNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DAVID L GOLDFEIN ST
HOLLOMAN AIR FORCE BASE NM
88330-8273
US

IV. Provider business mailing address

280 DAVID L GOLDFEIN ST
HOLLOMAN AIR FORCE BASE NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-2778
  • Fax:
Mailing address:
  • Phone: 575-572-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025033610
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: