MEDICARE: DR. VINCENT P SKOTKO PH.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	103TB0200X	Cognitive & Behavioral Psychologist	PY2791	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185670	OTHER	FL	PROVIDER NUMBER

General Provider Information

NPI Number	:	1992861793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT P SKOTKO PH.D.

Provider Business Mailing Address
First Line	:	722 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3133
Country	:	US
Telephone Number	:	813-224-0249
Fax Number	:	813-228-0192

Provider Business Practice Location Address
First Line	:	722 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3133
Country	:	US
Telephone Number	:	813-224-0249
Fax Number	:	813-228-0192

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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