Provider Demographics
NPI:1598851925
Name:SKIBSTED, ROBERT CLARENCE (IDC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CLARENCE
Last Name:SKIBSTED
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 485 BOX 359
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96321-0004
Mailing Address - Country:US
Mailing Address - Phone:312-252-8877
Mailing Address - Fax:
Practice Address - Street 1:PSC 485 BOX 359
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96321-0004
Practice Address - Country:US
Practice Address - Phone:312-252-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman