Provider Demographics
NPI:1952386468
Name:SKANKEY, GARY RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:SKANKEY
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 1:7200 CATHEDRAL ROCK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0430
Mailing Address - Country:US
Mailing Address - Phone:702-737-0740
Mailing Address - Fax:702-737-1402
Practice Address - Street 1:7200 CATHEDRAL ROCK DR STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0430
Practice Address - Country:US
Practice Address - Phone:702-723-4124
Practice Address - Fax:702-867-0066
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6415207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002420Medicaid
NV11WCCBX04Medicare ID - Type Unspecified
NVF31534Medicare UPIN