Organization
DOUGLAS R SWINEHART M D PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS R. SWINEHART M.D. (PRESIDENT)
(559) 432-1212
Entity
Organization
Contact information
Practice address
6335 N FRESNO ST, SUITE 201, FRESNO, CA 93710-5272
(559) 432-1212
(559) 432-6669
Mailing address
6335 N FRESNO ST, SUITE 201, FRESNO, CA 93710-5272
(559) 432-1212
(559) 432-6669
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G415040
CA
207ND0900X
Dermatopathology Physician
G415040
CA
207NS0135X
Procedural Dermatology Physician
G415040
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ05982Z
MEDICARE PTAN
CA
Enumeration date
03/22/2007
Last updated
06/15/2015
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