Provider Demographics
NPI:1821146242
Name:SKEDROS, DEMETRIOS GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:GREGORY
Last Name:SKEDROS
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 1:2255 N 1700 W
Mailing Address - Street 2:STE 200
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1187
Mailing Address - Country:US
Mailing Address - Phone:801-776-2180
Mailing Address - Fax:801-776-2534
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7667
Practice Address - Country:US
Practice Address - Phone:801-295-5581
Practice Address - Fax:801-295-9253
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264339-1205207Y00000X
WY5387A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108797500Medicaid
UT005746003Medicare PIN
WY21408Medicare PIN
WY108797500Medicaid
UTF62486Medicare UPIN