Provider Demographics
NPI:1083621569
Name:SKILES, STEVEN LEO (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEO
Last Name:SKILES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 HAWKINS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3921
Mailing Address - Country:US
Mailing Address - Phone:817-735-9397
Mailing Address - Fax:817-735-8340
Practice Address - Street 1:7257 HAWKINS VIEW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3921
Practice Address - Country:US
Practice Address - Phone:817-735-9397
Practice Address - Fax:817-735-8340
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03657207X00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285297202Medicaid
TX285297201Medicaid
TX285297203Medicaid
TX285297203Medicaid
TXTXB138784Medicare PIN
TX285297201Medicaid
TX285297202Medicaid
TXTXB138783Medicare PIN