Provider Demographics
NPI:1295149060
Name:SKOGMAN, PADGET ELIZABETH SMITH (MD)
Entity type:Individual
Prefix:DR
First Name:PADGET
Middle Name:ELIZABETH SMITH
Last Name:SKOGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADGET
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 10TH ST SE # LEVEL4
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1251
Mailing Address - Country:US
Mailing Address - Phone:319-861-7900
Mailing Address - Fax:319-861-7950
Practice Address - Street 1:701 10TH ST SE # LEVEL4
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-861-7900
Practice Address - Fax:318-861-7950
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-44894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics