Healthcare Provider Details

I. General information

NPI: 1053305391
Provider Name (Legal Business Name): GALE J. SKOUSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 N STATE ROAD 198 STE 203
SALEM UT
84653-5668
US

IV. Provider business mailing address

336 W 100 S
SPANISH FORK UT
84660-5881
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-9802
  • Fax:
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number184332-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: