Provider Demographics
NPI:1639359821
Name:TERRY L SWEZEY MD PA
Entity Type:Organization
Organization Name:TERRY L SWEZEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEITH
Authorized Official - Last Name:SWEZEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-6400
Mailing Address - Street 1:1800 43RD AVE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0573
Mailing Address - Country:US
Mailing Address - Phone:772-569-6400
Mailing Address - Fax:772-567-4123
Practice Address - Street 1:1800 43RD AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0573
Practice Address - Country:US
Practice Address - Phone:772-569-6400
Practice Address - Fax:772-567-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15745OtherBLUE CROSS BLUE SHIELD
FLD67129Medicare UPIN
FLK2462Medicare PIN