Basic Information
| Provider Information | |||||||||
| NPI: | 1336323088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKELDING | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8100 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973030900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033992424 | ||||||||
| FaxNumber: | 5033757429 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 CAPITOL ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973010644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033992424 | ||||||||
| FaxNumber: | 5033757429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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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 | 207R00000X | MD202269 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD.202269 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD184809 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1079871 | 05 | LA | MEDICAID | 1228590005 | 01 | OR | NCS | OTHER | 500732667 | 05 | OR | MEDICAID | 08375807 | 05 | MS | MEDICAID |