Healthcare Provider Details

I. General information

NPI: 1083819114
Provider Name (Legal Business Name): K. BYRON SKUBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAIN STREET
COUPEVILLE WA
98239
US

IV. Provider business mailing address

80 N. MAIN STREET
COUPEVILLE WA
98239
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-4424
  • Fax: 360-678-5161
Mailing address:
  • Phone: 360-678-4424
  • Fax: 360-678-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number00017538
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: