Provider Demographics
NPI:1710131511
Name:SKABELUND, ANDREW JACOB (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JACOB
Last Name:SKABELUND
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 1:619 S FLEISHEL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2004
Mailing Address - Country:US
Mailing Address - Phone:903-606-2299
Mailing Address - Fax:903-606-2838
Practice Address - Street 1:619 S FLEISHEL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2004
Practice Address - Country:US
Practice Address - Phone:903-606-2299
Practice Address - Fax:903-606-2838
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.015588207R00000X
IN01068141A207R00000X, 207RP1001X
TXQ1909207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine