Provider Demographics
NPI:1720272727
Name:SWICEGOOD, ERICA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:SWICEGOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:HULENTOWER NORTH
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-569-4300
Mailing Address - Fax:817-569-4494
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:HULENTOWER NORTH
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4300
Practice Address - Fax:817-569-4494
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-02
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN82482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296522001Medicaid
TX296522002OtherCSHCN MEDICAID NUMBER
TX8DC927OtherBLUE CROSS BLUE SHIELD NUMBER
TX296522001Medicaid