Provider Demographics
NPI:1467426668
Name:SWEARNGIN, STEPHAN EARL (DO)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:EARL
Last Name:SWEARNGIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4625
Mailing Address - Country:US
Mailing Address - Phone:775-445-8781
Mailing Address - Fax:775-888-3225
Practice Address - Street 1:975 RYLAND ST
Practice Address - Street 2:STE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1667
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-5225
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1467426668Medicaid
NVP00157000OtherRR MEDICARE
11041969OtherCAQH
NVV40430Medicare PIN
NVV38979Medicare PIN
NVP00157000OtherRR MEDICARE