Healthcare Provider Details

I. General information

NPI: 1184120495
Provider Name (Legal Business Name): HUNTER SKOOG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 WALNUT HILL DR
LONGVIEW TX
75605-5052
US

IV. Provider business mailing address

912 WALNUT HILL DR
LONGVIEW TX
75605-5052
US

V. Phone/Fax

Practice location:
  • Phone: 903-291-6300
  • Fax: 903-291-6305
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberU3655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: