Provider Demographics
NPI:1861436644
Name:PAUL H SKAGGS MD PA
Entity type:Organization
Organization Name:PAUL H SKAGGS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-299-5121
Mailing Address - Street 1:1485 37TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6500
Mailing Address - Country:US
Mailing Address - Phone:772-569-9745
Mailing Address - Fax:772-567-6868
Practice Address - Street 1:1485 37TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6500
Practice Address - Country:US
Practice Address - Phone:772-569-9745
Practice Address - Fax:772-567-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00531Medicare ID - Type Unspecified