Provider Demographics
NPI:1538377833
Name:SKARUPA, DAVID JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:SKARUPA
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:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1015
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD, 2ED
Practice Address - Street 2:ECU BRODY SCHOOL OF MEDICINE DEPT OF SURGERY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-847-4299
Practice Address - Fax:252-847-8208
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086454208600000X
NC2011-01347208600000X, 2086S0102X
FLME1165132086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC165J5OtherBCBSNC
NC5918535Medicaid
NCNC1909AMedicare PIN