Provider Demographics
NPI:1700449295
Name:SKUTHAN, JERRY PATRICK (DO)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:PATRICK
Last Name:SKUTHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 402
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7520
Mailing Address - Country:US
Mailing Address - Phone:919-567-6133
Mailing Address - Fax:919-567-6134
Practice Address - Street 1:4414 LAKE BOONE TRL STE 402
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7520
Practice Address - Country:US
Practice Address - Phone:919-567-6133
Practice Address - Fax:919-567-6134
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-02910207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology