Provider Demographics
NPI:1750314860
Name:SWOBODA, JAYE T (MD)
Entity Type:Individual
Prefix:
First Name:JAYE
Middle Name:T
Last Name:SWOBODA
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 1:219 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-0547
Mailing Address - Country:US
Mailing Address - Phone:406-682-4223
Mailing Address - Fax:406-682-3874
Practice Address - Street 1:219 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-0547
Practice Address - Country:US
Practice Address - Phone:406-682-4223
Practice Address - Fax:406-682-3874
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C93899Medicare UPIN