Provider Demographics
NPI:1962470948
Name:SKAGGS, GREGORY C (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:C
Last Name:SKAGGS
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 1:2727 LEO HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8835
Mailing Address - Country:US
Mailing Address - Phone:541-346-2257
Mailing Address - Fax:855-850-1265
Practice Address - Street 1:2727 LEO HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8835
Practice Address - Country:US
Practice Address - Phone:541-346-2257
Practice Address - Fax:855-850-1265
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19982207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080908Medicaid
G13134Medicare UPIN
R114515Medicare PIN
ORRR PTAN 080088224Medicare PIN
OR080908Medicaid