MEDICARE: ROBERT E SKINNER 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	208800000X	Urology Physician	MD15065	OR
2	208800000X	Urology Physician	MD00034524	WA

General Provider Information

NPI Number	:	1366545394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E SKINNER M.D.

Provider Business Mailing Address
First Line	:	9427 SW BARNES RD
Second Line	:	UROLOGY, SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97225-6652
Country	:	US
Telephone Number	:	503-203-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	9427 SW BARNES RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-7225
Country	:	US
Telephone Number	:	503-203-2040
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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