Provider Demographics
NPI:1043261902
Name:SKAGGS, GREGORY GORDON (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:GORDON
Last Name:SKAGGS
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 1:910 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-2414
Mailing Address - Country:US
Mailing Address - Phone:270-259-9651
Mailing Address - Fax:270-259-9582
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2414
Practice Address - Country:US
Practice Address - Phone:270-259-9651
Practice Address - Fax:270-259-9582
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY203767609OtherPHCS
KY203767609OtherUNICARE
KY203767609OtherHUMANA
KY203767609OtherUNITED HEALTH CARE
KY4349009OtherATENA
KY203767609OtherTRICARE
KY64240930Medicaid
KY203767609OtherGREAT WEST LIFE
KY207677609OtherCIGNA
KY2434505000OtherPASSPORT ADVANTAGE
KY9947Medicare ID - Type Unspecified
KY203767609OtherHUMANA