Individual
JUSTIN STUART SKIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3403 E KNOLLWOOD ST, TAMPA, FL 33610-1550
(863) 267-4104
Mailing address
3403 E KNOLLWOOD ST, TAMPA, FL 33610-1550
(863) 267-4104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9110082
FL
Other
Enumeration date
03/14/2017
Last updated
03/30/2017
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