Provider Demographics
NPI:1013954593
Name:SKRAINKA, BRIAN S (MD)
Entity type:Individual
Prefix:
First Name:BRIAN S
Middle Name:
Last Name:SKRAINKA
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 1:11014 S GUM ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-9004
Mailing Address - Country:US
Mailing Address - Phone:314-914-1112
Mailing Address - Fax:
Practice Address - Street 1:11014 S GUM ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-9004
Practice Address - Country:US
Practice Address - Phone:314-914-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMED R3H732080P0204X
IL036-1018882080P0204X
MN561152080P0204X
TXM45482080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine