Healthcare Provider Details

I. General information

NPI: 1316908205
Provider Name (Legal Business Name): DANIEL MARK SKOTTE SR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56056 BEAVER DRIVE
SUNRIVER OR
97707
US

IV. Provider business mailing address

PO BOX 3572
SUNRIVER OR
97707-0572
US

V. Phone/Fax

Practice location:
  • Phone: 541-593-5400
  • Fax: 541-593-4076
Mailing address:
  • Phone: 541-593-5400
  • Fax: 541-593-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO13485
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13485
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: