Provider Demographics
NPI:1083619142
Name:SKOOG, ROBERT E (DOM, RX2)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:SKOOG
Suffix:
Gender:M
Credentials:DOM, RX2
Other - Prefix:DR
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:SKOOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM RX2
Mailing Address - Street 1:9817 RIVERSIDE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1970
Mailing Address - Country:US
Mailing Address - Phone:505-890-4319
Mailing Address - Fax:505-890-1839
Practice Address - Street 1:9817 RIVERSIDE RD NW
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:NM
Practice Address - Zip Code:87114-1970
Practice Address - Country:US
Practice Address - Phone:505-890-4319
Practice Address - Fax:505-890-1839
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM789171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist