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General NPI Number Information
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NPI Number | 1699893040
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Entity Type | Organization
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Legal Business Name | PHILLIP H SKINNER MD PA
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 S MAIN ST STE 110
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-332-4363
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Fax | 817-332-5100
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Provider Business Mailing Address
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Address Line | 1350 S MAIN ST STE 110
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-332-4363
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Fax | 817-332-5100
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP HOWARD SKINNER
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Credential | MD
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Telephone | 817-332-4363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E7737
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License Number State | TX
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