1427035757 NPI number — DR. DOWZELL MEDFORD SWAYNGIM JR. MD

Table of content: DR. DOWZELL MEDFORD SWAYNGIM JR. MD (NPI 1427035757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427035757 NPI number — DR. DOWZELL MEDFORD SWAYNGIM JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAYNGIM
Provider First Name:
DOWZELL
Provider Middle Name:
MEDFORD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427035757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 TYLER ST
Provider Second Line Business Mailing Address:
STE 351
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44870-3391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-621-7620
Provider Business Mailing Address Fax Number:
419-621-7623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 TYLER ST
Provider Second Line Business Practice Location Address:
SUITE 251
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44870-3367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-625-0599
Provider Business Practice Location Address Fax Number:
419-625-3704
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  041426 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3700343 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0349840 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341328997011 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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