Healthcare Provider Details

I. General information

NPI: 1215970926
Provider Name (Legal Business Name): MATTHEW R SWELSTAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 FORESIGHT CIR UNIT 100
GRAND JUNCTION CO
81505-1156
US

IV. Provider business mailing address

2515 FORESIGHT CIR UNIT 200
GRAND JUNCTION CO
81505-1156
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-8177
  • Fax: 970-255-3558
Mailing address:
  • Phone: 970-245-2400
  • Fax: 970-242-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDR.0045750
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberDR.0045750
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: