Provider Demographics
NPI:1336172956
Name:SKAVARIL, JAMES V (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:SKAVARIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2956
Mailing Address - Country:US
Mailing Address - Phone:503-230-9224
Mailing Address - Fax:503-230-9201
Practice Address - Street 1:5050 NE HOYT ST STE 203
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2956
Practice Address - Country:US
Practice Address - Phone:503-230-9224
Practice Address - Fax:503-230-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130094Medicaid
ORR144467Medicare PIN
G85615Medicare UPIN