Healthcare Provider Details

I. General information

NPI: 1679717730
Provider Name (Legal Business Name): MATTHEW JOHN SWENSON MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S RAINBOW BLVD STE 302
LAS VEGAS NV
89118-1896
US

IV. Provider business mailing address

5320 S RAINBOW BLVD STE 302
LAS VEGAS NV
89118-1896
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-8222
  • Fax: 702-563-3390
Mailing address:
  • Phone: 702-382-8222
  • Fax: 702-563-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21619
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: