Healthcare Provider Details

I. General information

NPI: 1104988583
Provider Name (Legal Business Name): DANIEL J SKARZYNSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 THOMPSON RD
COOS BAY OR
97420-2198
US

IV. Provider business mailing address

5003 HARDY ST STE 200
HATTIESBURG MS
39402-1331
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-8111
  • Fax:
Mailing address:
  • Phone: 601-261-5700
  • Fax: 601-261-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25209
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberCP200550
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: