Provider Demographics
NPI:1427599893
Name:SKIDMORE, BILLY (OPA)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:OPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N HIGHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7383
Mailing Address - Country:US
Mailing Address - Phone:903-868-8800
Mailing Address - Fax:903-868-4405
Practice Address - Street 1:425 N HIGHLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7383
Practice Address - Country:US
Practice Address - Phone:903-868-8800
Practice Address - Fax:903-868-4405
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant