Provider Demographics
NPI: | 1518962752 |
---|---|
Name: | SWYGERT, THOMAS H (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | THOMAS |
Middle Name: | H |
Last Name: | SWYGERT |
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: | PO BOX 840853 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75284-0853 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-715-5000 |
Mailing Address - Fax: | 972-715-9976 |
Practice Address - Street 1: | 6606 LBJ FWY |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75240 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-715-5000 |
Practice Address - Fax: | 972-715-9976 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-15 |
Last Update Date: | 2018-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | G0180 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | P01446020 | Other | RR |
TX | 110119810 | Medicaid | |
TX | 8EH540 | Other | BCBS |
TX | 341095YK6U | Medicare PIN | |
TX | P01446020 | Other | RR |
TX | 8BH384 | Other | BCBS |
TX | 8L6421 | Medicare UPIN | |
TX | 110119805 | Medicaid | |
TX | 110119806 | Medicaid |