Provider Demographics
NPI:1073617197
Name:SKINNER, HOMER L (DO)
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:L
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8702
Mailing Address - Country:US
Mailing Address - Phone:330-729-2388
Mailing Address - Fax:330-629-6468
Practice Address - Street 1:107 ROYAL BIRKDALE DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8493
Practice Address - Country:US
Practice Address - Phone:330-482-9350
Practice Address - Fax:330-482-2336
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34003396S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0552745Medicaid
A15835Medicare UPIN
OH0552745Medicaid