Provider Demographics
NPI:1124040266
Name:SKYIEPAL, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SKYIEPAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 N HIGHWAY 77
Mailing Address - Street 2:STE 501-C #239
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1977
Mailing Address - Country:US
Mailing Address - Phone:888-558-5756
Mailing Address - Fax:888-558-5754
Practice Address - Street 1:208 S 14TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4117
Practice Address - Country:US
Practice Address - Phone:360-814-2600
Practice Address - Fax:360-814-8390
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1570208D00000X, 208600000X
WAMD61639297208600000X
WI2334208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046230104Medicaid
TX046230105Medicaid
TX046230106Medicaid
WI100217995Medicaid
TX8J3195Medicare ID - Type Unspecified
TX046230104Medicaid
TX8L2354Medicare PIN
TX8L2352Medicare PIN
TX8G1942Medicare ID - Type Unspecified
TX046230105Medicaid