Provider Demographics
NPI:1760034045
Name:SWIFTWATER DERMATOLOGY
Entity Type:Organization
Organization Name:SWIFTWATER DERMATOLOGY
Other - Org Name:SWIFTWATER DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-398-3376
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1243
Mailing Address - Country:US
Mailing Address - Phone:907-398-3376
Mailing Address - Fax:907-420-0435
Practice Address - Street 1:130 E REDOUBT AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8012
Practice Address - Country:US
Practice Address - Phone:907-398-3376
Practice Address - Fax:907-420-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty