Provider Demographics
NPI:1326022534
Name:SWETNAM, JEFFREY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:SWETNAM
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 1:3623 JOHNSON MILL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6413
Mailing Address - Country:US
Mailing Address - Phone:479-966-4174
Mailing Address - Fax:479-301-2516
Practice Address - Street 1:3623 JOHNSON MILL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6413
Practice Address - Country:US
Practice Address - Phone:479-966-4174
Practice Address - Fax:479-301-5334
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25365208600000X
ARE-9062208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200462050TMedicaid
OK200218280AMedicaid
OK200218280AMedicaid
OK900522214Medicare PIN
OKOKAAA0257Medicare PIN
OKOKAAA0257Medicare PIN