Provider Demographics
NPI:1184683799
Name:SKWERER, ROBERT GORDON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GORDON
Last Name:SKWERER
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 1:8304 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1697
Mailing Address - Country:US
Mailing Address - Phone:919-870-8409
Mailing Address - Fax:877-622-8953
Practice Address - Street 1:3342 NE 34TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6906
Practice Address - Country:US
Practice Address - Phone:833-533-4626
Practice Address - Fax:877-622-8953
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0514482084P0800X
MDD00350812084P0800X
NC99001342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184683799Medicaid