Healthcare Provider Details

I. General information

NPI: 1205834553
Provider Name (Legal Business Name): ERIK DALE SKOOG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S BERNARD ST
SPOKANE WA
99204-2509
US

IV. Provider business mailing address

427 S BERNARD ST
SPOKANE WA
99204-2509
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-0107
  • Fax: 509-747-2635
Mailing address:
  • Phone: 509-456-0107
  • Fax: 509-747-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00041350
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: