Provider Demographics
NPI:1063431849
Name:SKIBO, SCOTT D (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:SKIBO
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8798
Practice Address - Country:US
Practice Address - Phone:102-955-5119
Practice Address - Fax:910-235-3421
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49312207RP1001X
NC2013-01304207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1168233OtherGATEWAY HEALTH
NC1805665OtherCIGNA
NCP01292147OtherRAILROAD MCR
NC1063431849Medicaid
NC1063431849Medicaid
FL1168233OtherGATEWAY HEALTH