Provider Demographics
NPI:1104870997
Name:SKIDMORE, TROY E (DO)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:E
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2709 MEREDYTH DR
Mailing Address - Street 2:STE 450
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0222
Mailing Address - Country:US
Mailing Address - Phone:229-446-1990
Mailing Address - Fax:229-312-5005
Practice Address - Street 1:2709 MEREDYTH DR
Practice Address - Street 2:STE 450
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0222
Practice Address - Country:US
Practice Address - Phone:229-446-1990
Practice Address - Fax:229-312-5005
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34008539207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I33389Medicare UPIN
OH5818980001Medicare NSC