Healthcare Provider Details

I. General information

NPI: 1245312982
Provider Name (Legal Business Name): JEFFREY T. SWAIL M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 PEARL ST. SUITE 300
BOULDER CO
80302
US

IV. Provider business mailing address

2575 PEARL ST. SUITE 300
BOULDER CO
80302
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-6666
  • Fax: 303-449-7023
Mailing address:
  • Phone: 303-449-6666
  • Fax: 303-449-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number34276
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01342765
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
IdentifierSW88401
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerB/C AND B/S PROVIDER ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: