Basic Information
| Provider Information | |||||||||
| NPI: | 1245322049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKIDMORE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 357730 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326357730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523717546 | ||||||||
| FaxNumber: | 3523357546 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 NW 83RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326065603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523717546 | ||||||||
| FaxNumber: | 3523357546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 06/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | ME59336 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
ID Information
| ID | Type | State | Issuer | Description | DC1427 | 01 | FL | RAILROAD MEDICARE GROUP# | OTHER |