Provider Demographics
NPI:1770509036
Name:SKOBLAR, ERIC S (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:SKOBLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1761 SUNSET CLIFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3217
Mailing Address - Country:US
Mailing Address - Phone:619-994-1739
Mailing Address - Fax:858-534-6023
Practice Address - Street 1:9500 GILMAN DR
Practice Address - Street 2:MAIL CODE 0039
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-5004
Practice Address - Country:US
Practice Address - Phone:858-534-1759
Practice Address - Fax:858-534-6023
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82263207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A822630Medicaid
CAI15439Medicare UPIN
CAWA85777AMedicare ID - Type Unspecified