Provider Demographics
NPI:1174870752
Name:SKINNER, MICHAEL H (MD, PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2881
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-5881
Mailing Address - Country:US
Mailing Address - Phone:858-337-0099
Mailing Address - Fax:
Practice Address - Street 1:4637 PARK DR APT 5
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4246
Practice Address - Country:US
Practice Address - Phone:858-337-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42789208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE30611Medicare UPIN