Individual
KENNETH H. SKIPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 BROADWAY AVE, GLADEWATER, TX 75647-5040
(903) 315-5630
(903) 845-6212
Mailing address
PO BOX 4207, LONGVIEW, TX 75606-4207
(903) 315-5630
(903) 845-6212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F5047
TX
208D00000X
General Practice Physician
Primary
F5047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123416301
—
TX
Enumeration date
06/17/2005
Last updated
09/23/2013
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