Provider Demographics
NPI:1659545176
Name:SKAGGS, LAUREN VROOMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:VROOMAN
Last Name:SKAGGS
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 1:938 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2505
Mailing Address - Country:US
Mailing Address - Phone:541-758-5047
Mailing Address - Fax:541-758-3713
Practice Address - Street 1:938 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2505
Practice Address - Country:US
Practice Address - Phone:541-758-5047
Practice Address - Fax:541-758-3713
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
CO52154390200000X
ORMD1666482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR175237OtherMEDICARE PTAN
OR500671677Medicaid
ORR175237OtherMEDICARE PTAN