Healthcare Provider Details

I. General information

NPI: 1417927120
Provider Name (Legal Business Name): MATTHEW SCOTT SWAIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/03/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 103
UKIAH CA
95482-4568
US

IV. Provider business mailing address

260 HOSPITAL DR STE 103
UKIAH CA
95482-4568
US

V. Phone/Fax

Practice location:
  • Phone: 707-467-3123
  • Fax:
Mailing address:
  • Phone: 707-467-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number4298
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4298
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: