Provider Demographics
NPI:1417160417
Name:SWAIN, JEREMY LLOYD (DO)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LLOYD
Last Name:SWAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 W CENTRAL TEXAS EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7469
Mailing Address - Country:US
Mailing Address - Phone:254-618-1186
Mailing Address - Fax:512-666-3748
Practice Address - Street 1:3800 S W S YOUNG DR STE 402
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3374
Practice Address - Country:US
Practice Address - Phone:254-833-8456
Practice Address - Fax:254-833-9162
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059211207Q00000X
TXN9415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine