Provider Demographics
NPI:1114928223
Name:SKENE, GEOFFREY K (DO)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:K
Last Name:SKENE
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:PO BOX 10490
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-0490
Mailing Address - Country:US
Mailing Address - Phone:307-733-3900
Mailing Address - Fax:307-732-0925
Practice Address - Street 1:555 E BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9496
Practice Address - Country:US
Practice Address - Phone:307-733-3900
Practice Address - Fax:307-732-0925
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6266A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71045Medicare UPIN