Provider Demographics
NPI:1205834553
Name:SKOOG, ERIK DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:DALE
Last Name:SKOOG
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 1:427 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-0107
Mailing Address - Fax:509-747-2635
Practice Address - Street 1:427 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-0107
Practice Address - Fax:509-747-2635
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041350207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA161203OtherLABOR AND INDUSTRIES
WA26128OtherGROUP HEALTH
IDKS442OtherBLUE CROSS OF IDAHO
WAWA 0690OtherNORTHWEST BENEFIT NETWORK
ID000010140674OtherASURIS (REGENCE BS OF ID)
WAS 2235SKOtherASURIS(REGENCE NW HEALTH)
WA8317018Medicaid
WAA028OtherTRICARE
WA26128OtherGROUP HEALTH
WA8317018Medicaid