Provider Demographics
NPI:1336179746
Name:SWANGARD, ROBERT J (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:SWANGARD
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-484-6133
Mailing Address - Fax:541-484-6133
Practice Address - Street 1:2885 ARLINE WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2527
Practice Address - Country:US
Practice Address - Phone:541-484-6133
Practice Address - Fax:541-484-6133
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD120182086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR19224-5Medicaid
ORA68090Medicare UPIN
ORR0000BHKVNMedicare ID - Type Unspecified