Provider Demographics
NPI:1851432835
Name:SKARDIS, JONAS R (DOM)
Entity Type:Individual
Prefix:DR
First Name:JONAS
Middle Name:R
Last Name:SKARDIS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SAINT MICHAELS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7686
Mailing Address - Country:US
Mailing Address - Phone:505-988-5551
Mailing Address - Fax:
Practice Address - Street 1:460 SAINT MICHAELS DR STE 200
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7686
Practice Address - Country:US
Practice Address - Phone:505-988-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM159RX2208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCS00207711OtherCONTROLLED SUBSTANCES REG
NMBS7701077OtherDEA REGISTRATION NUMBER