Provider Demographics
NPI:1235118951
Name:SKYLAR, ROMAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:EDWARD
Last Name:SKYLAR
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 1:209 N ATLANTIC BLVD
Mailing Address - Street 2:APT.2C
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-4365
Mailing Address - Country:US
Mailing Address - Phone:954-463-8237
Mailing Address - Fax:954-463-8237
Practice Address - Street 1:209 N ATLANTIC BLVD
Practice Address - Street 2:APT.2C
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-4365
Practice Address - Country:US
Practice Address - Phone:954-463-8237
Practice Address - Fax:954-463-8237
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85138207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264816400Medicaid
FL51970OtherBCBS
FL264816400Medicaid
H66967Medicare UPIN