Provider Demographics
NPI:1538121041
Name:SWYERS, JERRY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:SCOTT
Last Name:SWYERS
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 1:1030 PINE POINT RD
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2773
Mailing Address - Country:US
Mailing Address - Phone:561-842-1311
Mailing Address - Fax:
Practice Address - Street 1:1030 PINE POINT RD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2773
Practice Address - Country:US
Practice Address - Phone:561-842-1311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55790Medicare UPIN