MEDICARE: TRACIE DENISE SWAYDEN 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	207ND0900X	Dermatopathology Physician	L8526	TX

General Provider Information

NPI Number	:	1093865545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE DENISE SWAYDEN MD

Provider Business Mailing Address
First Line	:	804 NE MALL BLVD
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4653
Country	:	US
Telephone Number	:	817-595-4500
Fax Number	:	817-595-4505

Provider Business Practice Location Address
First Line	:	804 NE MALL BLVD
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4653
Country	:	US
Telephone Number	:	817-595-4500
Fax Number	:	817-595-4505

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	11/10/2011

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Directions to “ TRACIE DENISE SWAYDEN MD” Practice Location

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