MEDICARE: GALE J. SKOUSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	184332-1205	UT

General Provider Information

NPI Number	:	1053305391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALE J. SKOUSEN M.D.

Provider Business Mailing Address
First Line	:	336 W 100 S
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-5881
Country	:	US
Telephone Number	:	801-798-7301
Fax Number	:	801-798-8513

Provider Business Practice Location Address
First Line	:	591 N STATE ROAD 198 STE 203
Second Line	:
City	:	SALEM
State	:	UT
Zip	:	84653-5668
Country	:	US
Telephone Number	:	801-465-9802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/28/2023

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