Provider Demographics
NPI:1225020779
Name:SWINEY, DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SWINEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-1226
Mailing Address - Country:US
Mailing Address - Phone:432-334-8088
Mailing Address - Fax:432-580-7202
Practice Address - Street 1:520 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4527
Practice Address - Country:US
Practice Address - Phone:432-334-8088
Practice Address - Fax:432-580-7202
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664497367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2182Medicare ID - Type Unspecified