Provider Demographics
NPI:1316908205
Name:SKOTTE, DANIEL MARK SR (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARK
Last Name:SKOTTE
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3572
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707-0572
Mailing Address - Country:US
Mailing Address - Phone:541-593-5400
Mailing Address - Fax:541-593-4076
Practice Address - Street 1:56056 BEAVER DRIVE
Practice Address - Street 2:
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707
Practice Address - Country:US
Practice Address - Phone:541-593-5400
Practice Address - Fax:541-593-4076
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO13485207Q00000X
OR13485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC93929Medicare UPIN