Provider Demographics
NPI:1043229354
Name:SKOUSEN, ROY NIELS (DO)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:NIELS
Last Name:SKOUSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 COPPERFIELD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2187
Mailing Address - Country:US
Mailing Address - Phone:405-624-1097
Mailing Address - Fax:405-624-1556
Practice Address - Street 1:3001 BROADMOOR BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-2100
Practice Address - Country:US
Practice Address - Phone:505-994-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020021402207L00000X
CO0060187207L00000X
GA87733207L00000X
AZ2214207L00000X
OK2569207L00000X
NH18886207L00000X
IN02007573A207L00000X
NMA-2467-21207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty