Provider Demographics
NPI:1144214230
Name:SWINEHART, DOUGLAS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:SWINEHART
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 1:6335 N FRESNO ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5272
Mailing Address - Country:US
Mailing Address - Phone:559-432-1212
Mailing Address - Fax:559-432-6669
Practice Address - Street 1:6335 N FRESNO ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5272
Practice Address - Country:US
Practice Address - Phone:559-432-1212
Practice Address - Fax:559-432-6669
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2015-06-15
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-19
Provider Licenses
StateLicense IDTaxonomies
CAG415040207NS0135X, 207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G415040Medicaid
CAA48587Medicare UPIN
CA00G415040Medicare PIN
CA00G415040Medicare PIN