Provider Demographics
NPI:1992838726
Name:SKINNER, PHILLIP HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:HOWARD
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 1:1350 S MAIN ST
Mailing Address - Street 2:#1100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-332-4363
Mailing Address - Fax:817-332-5100
Practice Address - Street 1:1350 S MAIN ST
Practice Address - Street 2:#1100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-332-4363
Practice Address - Fax:817-332-5100
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7737207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BH97Medicare ID - Type Unspecified
B26492Medicare UPIN