Provider Demographics
NPI:1770648776
Name:SKALA, TIMOTHY W (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:SKALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 BUSINESS BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7742
Mailing Address - Country:US
Mailing Address - Phone:907-694-2807
Mailing Address - Fax:907-694-7110
Practice Address - Street 1:11940 BUSINESS BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7742
Practice Address - Country:US
Practice Address - Phone:907-694-2807
Practice Address - Fax:907-694-7110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKMD 1211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 1211Medicaid
AKMD 1211Medicaid
AKC98298Medicare UPIN