Basic Information
| Provider Information | |||||||||
| NPI: | 1043229354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKOUSEN | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | NIELS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2112 COPPERFIELD | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740742187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056241097 | ||||||||
| FaxNumber: | 4056241556 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 BROADMOOR BLVD NE | ||||||||
| Address2: | |||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871442100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059947000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0060187 | CO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2214 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2569 | OK | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 18886 | NH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 87733 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2020021402 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A-2467-21 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.