Healthcare Provider Details

I. General information

NPI: 1144214230
Provider Name (Legal Business Name): DOUGLAS ROBERT SWINEHART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/19/2006

III. Provider practice location address

6335 N FRESNO ST SUITE 201
FRESNO CA
93710-5272
US

IV. Provider business mailing address

6335 N FRESNO ST SUITE 201
FRESNO CA
93710-5272
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-1212
  • Fax: 559-432-6669
Mailing address:
  • Phone: 559-432-1212
  • Fax: 559-432-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG415040
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG415040
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG415040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: