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General NPI Number Information
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NPI Number | 1669849485
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Entity Type | Organization
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Legal Business Name | RUSSELL B SKINNER MD PA
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 5072 W PLANO PKWY SUITE 200
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City | PLANO
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State | TX
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Zip | 75093-4476
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Country | US
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Telephone | 469-661-1100
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Fax | 469-661-1104
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Provider Business Mailing Address
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Address Line | 5072 W PLANO PKWY SUITE 200
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City | PLANO
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State | TX
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Zip | 75093-4476
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Country | US
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Telephone | 469-661-1100
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Fax | 469-661-1104
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUSSELL BRENT SKINNER
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Credential | MD
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Telephone | 469-661-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K5697
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License Number State | TX
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