Provider Demographics
NPI:1114911997
Name:SWEZEY, TERRY LEITH (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEITH
Last Name:SWEZEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 43RD AVE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0573
Mailing Address - Country:US
Mailing Address - Phone:772-569-6400
Mailing Address - Fax:772-567-4123
Practice Address - Street 1:1800 43RD AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0573
Practice Address - Country:US
Practice Address - Phone:772-569-6400
Practice Address - Fax:772-567-4123
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2009-06-18
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
FLME0040405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D67129Medicare UPIN
FL15745WMedicare ID - Type Unspecified