Provider Demographics
NPI:1265543524
Name:SKAZIAK, GERARD A (DPM)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:A
Last Name:SKAZIAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-0404
Mailing Address - Country:US
Mailing Address - Phone:256-582-7486
Mailing Address - Fax:256-582-9844
Practice Address - Street 1:1604 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1840
Practice Address - Country:US
Practice Address - Phone:256-582-7486
Practice Address - Fax:256-582-9844
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1205OtherLVFFC STATE LICENSE
AL38652OtherHEALTH PARTNERS
1265543524OtherNPI INDIVIDUAL #
AL9861OtherGUNTERSVILLE CITY LICENSE
AL000078853 (5738)Medicaid
AL00171OtherCONTROLLED SUBSTANCE LICE
AL2710035OtherUNITED HEALTH CARE
721400816OtherNEW TAX ID #
AL171OtherAL STATE LICENSE
AL480024856OtherRAILROAD MEDICARE
631189931OtherOLD TAX ID #
1253800001OtherDMERC #
1306045588OtherGROUP NPI #
1306045588OtherGROUP NPI #
1306045588OtherGROUP NPI #
AL480024856OtherRAILROAD MEDICARE