Provider Demographics
NPI:1992231500
Name:GARY SKANKEY, MD, PC
Entity type:Organization
Organization Name:GARY SKANKEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:REVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-229-3849
Mailing Address - Street 1:7200 CATHEDRAL ROCK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0430
Mailing Address - Country:US
Mailing Address - Phone:702-723-4124
Mailing Address - Fax:702-867-0066
Practice Address - Street 1:7200 CATHEDRAL ROCK DR STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0430
Practice Address - Country:US
Practice Address - Phone:702-723-4124
Practice Address - Fax:702-867-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty