Provider Demographics
NPI:1699190777
Name:MATTHEW D SKINNER, MD, P.C.
Entity Type:Organization
Organization Name:MATTHEW D SKINNER, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-734-7414
Mailing Address - Street 1:6740 W DEER VALLEY RD STE D107
Mailing Address - Street 2:PMB 105
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6740 W DEER VALLEY RD STE D107
Practice Address - Street 2:PMB 105
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5952
Practice Address - Country:US
Practice Address - Phone:623-734-7414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46497207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty