MEDICARE: BOYD A SKINNER PA

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	207N00000X	Dermatology Physician	ME30859	FL

General Provider Information

NPI Number	:	1457688400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYD A SKINNER PA

Provider Business Mailing Address
First Line	:	4301 SPANISH TRL
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4942
Country	:	US
Telephone Number	:	850-434-3000
Fax Number	:	850-469-8196

Provider Business Practice Location Address
First Line	:	4301 SPANISH TRL
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4942
Country	:	US
Telephone Number	:	850-434-3000
Fax Number	:	850-469-8196

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. BOYD A SKINNER
Credential	:	MD
Telephone Number	:	850-434-3000

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	11/12/2009

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