Provider Demographics
NPI:1164562526
Name:SKINNER, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SKINNER
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 1:800 ROSE ST
Mailing Address - Street 2:MN102
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-5625
Mailing Address - Fax:859-323-5289
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:MN102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-5625
Practice Address - Fax:859-323-5289
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY421562086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery