Provider Demographics
NPI:1285774661
Name:SKELTON, ELOISE (MD)
Entity type:Individual
Prefix:DR
First Name:ELOISE
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ELOISE
Other - Middle Name:
Other - Last Name:SKELTONFORREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 S 7TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3057
Mailing Address - Country:US
Mailing Address - Phone:760-256-1777
Mailing Address - Fax:760-256-7766
Practice Address - Street 1:500 S 7TH AVE STE D
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3057
Practice Address - Country:US
Practice Address - Phone:760-256-1777
Practice Address - Fax:760-256-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38025207V00000X
UT64166758017207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3601937OtherSTATE OF ILLINOIS
CA0G380251Medicaid
IA39442OtherSTATE
CACA141400Medicare PIN