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General NPI Number Information
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NPI Number | 1740280403
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Entity Type | Organization
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Legal Business Name | GREGORY SKIE MD PA
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 700 HUNTERS ROW CT
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City | MANSFIELD
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State | TX
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Zip | 76063-4001
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Country | US
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Telephone | 817-453-7771
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Fax | 817-453-6149
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Provider Business Mailing Address
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Address Line | 700 HUNTERS ROW CT
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City | MANSFIELD
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State | TX
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Zip | 76063-4001
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Country | US
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Telephone | 817-453-7771
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Fax | 817-453-6149
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY LYNN SKIE
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Credential | M.D.
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Telephone | 817-453-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | G5617
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License Number State | TX
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