Provider Demographics
NPI:1538129184
Name:SKIDMORE, LORI J (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:IN
Mailing Address - Zip Code:47359-1105
Mailing Address - Country:US
Mailing Address - Phone:765-728-2421
Mailing Address - Fax:765-728-8564
Practice Address - Street 1:121 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:IN
Practice Address - Zip Code:47359-1105
Practice Address - Country:US
Practice Address - Phone:765-728-2421
Practice Address - Fax:765-728-8564
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000179990OtherBLUE CROSS
IN000000179990OtherBLUE CROSS
IN070710BMedicare ID - Type Unspecified