Provider Demographics
NPI:1407960362
Name:SKAGGS, STANLEY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DEAN
Last Name:SKAGGS
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 1:3525 DEL MAR HEIGHTS RD
Mailing Address - Street 2:282
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2122
Mailing Address - Country:US
Mailing Address - Phone:858-554-0120
Mailing Address - Fax:
Practice Address - Street 1:3525 DEL MAR HEIGHTS RD
Practice Address - Street 2:282
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2122
Practice Address - Country:US
Practice Address - Phone:858-554-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39245207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G392450OtherBLUE SHIELD
3291421OtherCIGNA
CADN722ZOtherMEDICARE PTAN
0004125760OtherAETNA
330898160 920370000OtherTRICARE
CA00G392450Medicaid
CA330898160OtherBLUE CROSS
CA330898160OtherBLUE CROSS
3291421OtherCIGNA