=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316908205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL MARK SKOTTE SR. DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2006
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56056 BEAVER DRIVE
-----------------------------------------------------
City | SUNRIVER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-593-5400
-----------------------------------------------------
Fax | 541-593-4076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3572
-----------------------------------------------------
City | SUNRIVER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97707-0572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-593-5400
-----------------------------------------------------
Fax | 541-593-4076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO13485
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 13485
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------