Healthcare Provider Details

I. General information

NPI: 1669907804
Provider Name (Legal Business Name): COURTNEY MARIE SKOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/27/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SANDY CORNER RD
EL CAMPO TX
77437-9535
US

IV. Provider business mailing address

305 SANDY CORNER RD
EL CAMPO TX
77437-9535
US

V. Phone/Fax

Practice location:
  • Phone: 979-543-5510
  • Fax: 979-543-4137
Mailing address:
  • Phone: 979-543-5510
  • Fax: 979-543-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: