Provider Demographics
NPI:1245322049
Name:SKIDMORE, ROBERT JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SKIDMORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 357730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7730
Mailing Address - Country:US
Mailing Address - Phone:352-371-7546
Mailing Address - Fax:352-335-7546
Practice Address - Street 1:3700 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-371-7546
Practice Address - Fax:352-335-7546
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME59336207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC1427OtherRAILROAD MEDICARE GROUP#
FLDC1427OtherRAILROAD MEDICARE GROUP#
FLG43816Medicare UPIN
FLP00057075Medicare PIN
FL68814YMedicare PIN