MEDICARE: JOSEPH SPENCER SWICKARD M.D.

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	207X00000X	Orthopaedic Surgery Physician	C35168	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C35168	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1083618623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH SPENCER SWICKARD M.D.

Provider Business Mailing Address
First Line	:	1101 BRYAN AVE
Second Line	:	STE A
City	:	TUSTIN
State	:	CA
Zip	:	92780-4401
Country	:	US
Telephone Number	:	714-832-4731
Fax Number	:	714-832-8965

Provider Business Practice Location Address
First Line	:	1101 BRYAN AVE
Second Line	:	STE A
City	:	TUSTIN
State	:	CA
Zip	:	92780-4401
Country	:	US
Telephone Number	:	714-832-4731
Fax Number	:	714-832-8965

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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