Provider Demographics
NPI:1720139959
Name:SKELTON, AIXA (MD)
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2616
Mailing Address - Country:US
Mailing Address - Phone:904-743-1411
Mailing Address - Fax:904-743-1028
Practice Address - Street 1:6911 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2616
Practice Address - Country:US
Practice Address - Phone:904-743-1411
Practice Address - Fax:904-743-1028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057688300Medicaid
FL057688300Medicaid
FLC82707Medicare UPIN