Healthcare Provider Details

I. General information

NPI: 1790731941
Provider Name (Legal Business Name): DAVID M SKOLNICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

PO BOX 2417
CHEYENNE WY
82003-2417
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-0300
  • Fax: 307-638-0394
Mailing address:
  • Phone: 307-638-0300
  • Fax: 307-638-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7273A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: