Provider Demographics
NPI:1720113418
Name:SKIPPER, GREGORY E (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:SKIPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1408 N TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4274
Mailing Address - Country:US
Mailing Address - Phone:310-633-4595
Mailing Address - Fax:310-237-1639
Practice Address - Street 1:1408 N TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-4274
Practice Address - Country:US
Practice Address - Phone:310-633-4595
Practice Address - Fax:310-633-4595
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88361207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515833OtherBLUECROSS BLUESHIELD
AL051515833Medicaid
AL051515833OtherBLUECROSS BLUESHIELD
AL051515833Medicare UPIN