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Individual

DR. DANIEL PETERSON SKINNER JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2050 W SOUTHERN AVE STE 102, MESA, AZ 85202-4702
(480) 835-5532
(480) 962-0106
Mailing address
2050 W SOUTHERN AVE, 102, MESA, AZ 85202-4702
(480) 835-5532
(480) 962-0106

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2010010429
MO
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
48691
AZ
207NS0135X
Procedural Dermatology Physician
32259
AL
207NS0135X
Procedural Dermatology Physician
48691
AZ
207R00000X
Internal Medicine Physician
R71509
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
511-37085
BLUE
AL
Enumeration date
06/15/2009
Last updated
10/05/2020
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