Healthcare Provider Details

I. General information

NPI: 1558352203
Provider Name (Legal Business Name): CARL SKINNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR DEPARTMENT OF EMERGENCY MEDICINE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CTR DEPARTMENT OF EMERGENCY MEDICINE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1250
  • Fax:
Mailing address:
  • Phone: 253-968-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberMD 60148992
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5560815-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: