Provider Demographics
NPI:1275507170
Name:SKIPPER, GERALD WAYNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WAYNE
Last Name:SKIPPER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17808 NE CHARLIE JOHNS ST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-1052
Mailing Address - Country:US
Mailing Address - Phone:850-674-4524
Mailing Address - Fax:850-674-2300
Practice Address - Street 1:17808 NE CHARLIE JOHNS ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1052
Practice Address - Country:US
Practice Address - Phone:850-674-4524
Practice Address - Fax:850-674-2300
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254802000Medicaid
FL254802000Medicaid
FL32248VMedicare Oscar/Certification