Provider Demographics
NPI:1396856555
Name:SKINNER, ROBERT ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALFRED
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 1:1323 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4434
Mailing Address - Country:US
Mailing Address - Phone:903-794-1226
Mailing Address - Fax:903-794-1226
Practice Address - Street 1:1323 HAZEL ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4434
Practice Address - Country:US
Practice Address - Phone:903-794-1226
Practice Address - Fax:903-794-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2850207RG0100X
ARC5304207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54896OtherAR BC/BS
TX00SW92OtherTEXAS BC/BS
TX00SW92Medicare ID - Type Unspecified
AR54896OtherAR BC/BS