Individual
DR. MARK J SKELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3126 S JACKSON AVE, SUITE 102, JOPLIN, MO 64804-2534
(417) 556-3400
(417) 556-3401
Mailing address
3126 S JACKSON AVE, SUITE 102, JOPLIN, MO 64804-2534
(417) 556-3400
(417) 556-3401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R7C50
MO
207RH0003X
Hematology & Oncology Physician
MDR7C50
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100135900A
—
KS
05
—
100175490A
—
OK
05
—
201844727
—
MO
05
—
201844743
—
MO
01
—
25164
BLUE CROSS
MO
Enumeration date
03/02/2006
Last updated
10/19/2016
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