Provider Demographics
NPI:1205878766
Name:SKIPPER, KENT K (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:K
Last Name:SKIPPER
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 1:6513 PRESTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2688
Mailing Address - Country:US
Mailing Address - Phone:972-608-2025
Mailing Address - Fax:972-608-2032
Practice Address - Street 1:6513 PRESTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2688
Practice Address - Country:US
Practice Address - Phone:972-608-2025
Practice Address - Fax:972-608-2032
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6730174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042054906Medicaid
TX8W2744OtherBCBS
TX042054906Medicaid