Provider Demographics
NPI:1629289186
Name:SKEEHAN, DAVID MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:SKEEHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 RATTLESNAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9722
Mailing Address - Country:US
Mailing Address - Phone:916-250-2596
Mailing Address - Fax:916-550-5502
Practice Address - Street 1:584 N SUNRISE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2862
Practice Address - Country:US
Practice Address - Phone:916-250-2596
Practice Address - Fax:916-550-5025
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016113208600000X
CA20A 10739208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery