Provider Demographics
NPI:1215930334
Name:SKOTNICKI, ROBERT ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:SKOTNICKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8820
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:SUITE 810
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-674-8700
Practice Address - Fax:352-674-8714
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004652L207RC0000X
FLOS13035207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011376640001Medicaid
060012838OtherRAILROAD MEDICARE
060012838OtherRAILROAD MEDICARE
B41581Medicare UPIN