Provider Demographics
NPI:1467546481
Name:SKVERSKY, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SKVERSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:SKVERSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, INC
Mailing Address - Street 1:320 SUPERIOR AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2716
Mailing Address - Country:US
Mailing Address - Phone:949-645-2930
Mailing Address - Fax:949-645-1059
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-645-2930
Practice Address - Fax:949-645-1059
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine