Provider Demographics
NPI:1134220676
Name:SKOP, BRIAN PERRY (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PERRY
Last Name:SKOP
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 1:14815 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3708
Mailing Address - Country:US
Mailing Address - Phone:210-494-1991
Mailing Address - Fax:210-494-7575
Practice Address - Street 1:14815 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3708
Practice Address - Country:US
Practice Address - Phone:210-494-1991
Practice Address - Fax:210-494-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK67132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000745G5Medicaid
G84626Medicare UPIN
TX00745GMedicare ID - Type Unspecified