Provider Demographics
NPI:1912920976
Name:SWAYZE, SANDRA L (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SWAYZE
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 1:793 EASTERN BYP
Mailing Address - Street 2:SUITE G2
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2422
Mailing Address - Country:US
Mailing Address - Phone:859-626-0074
Mailing Address - Fax:859-626-3265
Practice Address - Street 1:793 EASTERN BYP
Practice Address - Street 2:SUITE G2
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2422
Practice Address - Country:US
Practice Address - Phone:859-626-0074
Practice Address - Fax:859-626-3265
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64282478Medicaid
KY4000501OtherMEDICARE LAB GROUP
KYP00102071OtherRR MEDICARE PIN
KYCB5773OtherRR MEDICARE GROUP
KY37903705OtherMEDICAID LAB GROUP
KY0369511Medicare ID - Type Unspecified
KY37903705OtherMEDICAID LAB GROUP
KY0685109Medicare PIN
KYCB5773OtherRR MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP