Provider Demographics
NPI:1942693809
Name:SKIDMORE, VERN VITO (CTRS)
Entity Type:Individual
Prefix:
First Name:VERN
Middle Name:VITO
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 S CYPRESS BEND DR
Mailing Address - Street 2:#707
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5631
Mailing Address - Country:US
Mailing Address - Phone:954-461-5492
Mailing Address - Fax:
Practice Address - Street 1:2206 S CYPRESS BEND DR
Practice Address - Street 2:#707
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5631
Practice Address - Country:US
Practice Address - Phone:954-461-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist