Provider Demographics
NPI:1811001936
Name:SKINNER, CLAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:R
Last Name:SKINNER
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 1:124 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1202
Mailing Address - Country:US
Mailing Address - Phone:210-224-1771
Mailing Address - Fax:210-229-9138
Practice Address - Street 1:124 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1202
Practice Address - Country:US
Practice Address - Phone:210-224-1771
Practice Address - Fax:210-229-9138
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7922208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX837535Medicare ID - Type Unspecified
TXB26496Medicare UPIN