Provider Demographics
NPI:1134279920
Name:SKOUMAL, STEVE M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:M
Last Name:SKOUMAL
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:PO BOX 2537
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2537
Mailing Address - Country:US
Mailing Address - Phone:208-233-3794
Mailing Address - Fax:208-233-3795
Practice Address - Street 1:1950 E CLARK ST
Practice Address - Street 2:SUITE D
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3314
Practice Address - Country:US
Practice Address - Phone:208-233-3794
Practice Address - Fax:208-233-3795
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7677207ZP0102X
IDM7677207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
820334553OtherTAX ID
ID002467700Medicaid
ID002467700Medicaid
U74298Medicare UPIN