Provider Demographics
NPI:1790712438
Name:SKINNER, DONALD G (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1441 EASTLAKE AVE
Mailing Address - Street 2:SUITE 7414
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0177
Mailing Address - Country:US
Mailing Address - Phone:323-865-3700
Mailing Address - Fax:323-865-0120
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:SUITE 7414
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0177
Practice Address - Country:US
Practice Address - Phone:323-865-3700
Practice Address - Fax:323-865-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG17316208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G173160Medicaid
CAG17316Medicare ID - Type Unspecified
CA00G173160Medicaid