Healthcare Provider Details

I. General information

NPI: 1780626853
Provider Name (Legal Business Name): ROBERT A. SKJONSBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 N MO PAC EXPY
AUSTIN TX
78758-2415
US

IV. Provider business mailing address

7410 REED DR
LEANDER TX
78641-9149
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-1000
  • Fax:
Mailing address:
  • Phone: 512-331-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG7590
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG7590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: