MEDICARE: JEREMY S. SWINDLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD26686	OR
2	207P00000X	Emergency Medicine Physician	2004022191	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053381889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY S. SWINDLE MD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N PROVIDENCE DR STE 210
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-7582
Country	:	US
Telephone Number	:	503-537-5900
Fax Number	:	503-537-5900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	02/16/2021

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