Provider Demographics
NPI:1861581563
Name:SKEBELSKY, ROGER WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WILLIAM
Last Name:SKEBELSKY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ROGER
Other - Middle Name:WILLIAM
Other - Last Name:SKEBELSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1089 SYDNEY COURT
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-7551
Mailing Address - Country:US
Mailing Address - Phone:402-403-1918
Mailing Address - Fax:
Practice Address - Street 1:100 E VALENCIA MESA DRIVE
Practice Address - Street 2:310
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-446-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001305363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical