Provider Demographics
NPI:1831151703
Name:SWICEGOOD, JOHN R (MD, FIPP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SWICEGOOD
Suffix:
Gender:M
Credentials:MD, FIPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10206
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0206
Mailing Address - Country:US
Mailing Address - Phone:479-452-0882
Mailing Address - Fax:479-314-5698
Practice Address - Street 1:7303 ROGERS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4106
Practice Address - Country:US
Practice Address - Phone:479-452-0882
Practice Address - Fax:479-314-5698
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3277207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90596Medicare UPIN
AR55121Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER