Provider Demographics
NPI:1255394920
Name:SKINNER, DEREK IAN (MD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:IAN
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 1:3420 22ND PLACE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-725-7800
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:7601 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3360
Practice Address - Country:US
Practice Address - Phone:806-725-9603
Practice Address - Fax:806-725-9600
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8646OtherBCBS
TX164626703Medicaid
TX138415101OtherFIRSTCARE
I04774Medicare UPIN
TX138415101OtherFIRSTCARE