Provider Demographics
NPI:1003887332
Name:SKIERKA, ROGER LELAND (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LELAND
Last Name:SKIERKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:513 N CHERRY ST
Mailing Address - City:SHELL ROCK
Mailing Address - State:IA
Mailing Address - Zip Code:50670
Mailing Address - Country:US
Mailing Address - Phone:319-885-6530
Mailing Address - Fax:319-885-6535
Practice Address - Street 1:513 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:SHELL ROCK
Practice Address - State:IA
Practice Address - Zip Code:50670
Practice Address - Country:US
Practice Address - Phone:319-885-6530
Practice Address - Fax:319-885-6535
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7138610Medicaid
IA49513Medicare ID - Type Unspecified
IA7138610Medicaid