Provider Demographics
NPI:1689202962
Name:SKIDMORE, TYLER JEFFREY FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JEFFREY FRANCIS
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3333
Mailing Address - Country:US
Mailing Address - Phone:304-663-8957
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program