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NPI Code Detail

MEDICARE: STANLEY D. SKAGGS, M.D. INC

MEDICARE: STANLEY D. SKAGGS, M.D. INC
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
1207RC0000XCardiovascular Disease Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5DN730AOTHERCAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G392450OTHERCABLUE SHIELD OF CALIFORNIA
23291421OTHERCIGNA
30004125760OTHERAETNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902005176
Entity Type Code : Organization
Provider Name (Legal Business Name) : STANLEY D. SKAGGS, M.D. INC
Provider Business Mailing Address
First Line : 12985 CLAYMONT CT
Second Line :
City : SAN DIEGO
State : CA
Zip : 92130-2431
Country : US
Telephone Number : 858-334-8656
Fax Number :
Provider Business Practice Location Address
First Line : 12985 CLAYMONT CT
Second Line :
City : SAN DIEGO
State : CA
Zip : 92130-2431
Country : US
Telephone Number : 858-334-8656
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. STANLEY D. SKAGGS
Credential : M.D.
Telephone Number : 858-334-8656
Provider Enumeration Date : 07/17/2007
Last Update Date : 09/14/2013

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