Provider Demographics
NPI:1427091073
Name:SKIPPER, STEWART ALLEN (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:ALLEN
Last Name:SKIPPER
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 1:4301 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2162
Mailing Address - Country:US
Mailing Address - Phone:863-385-1900
Mailing Address - Fax:863-385-9229
Practice Address - Street 1:4301 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2162
Practice Address - Country:US
Practice Address - Phone:863-385-1900
Practice Address - Fax:863-385-9229
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41089208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045115100Medicaid
P00039972OtherRAILROAD MEDICARE
FL30602OtherBCBS
P00039972OtherRAILROAD MEDICARE
FL30602OtherBCBS
FL30602YMedicare PIN