Healthcare Provider Details

I. General information

NPI: 1750414330
Provider Name (Legal Business Name): ROBERT J. SWANGARD, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E 11TH AVE STE 2A
EUGENE OR
97401-3683
US

IV. Provider business mailing address

655 E 11TH AVE STE 2A
EUGENE OR
97401-3683
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-6133
  • Fax: 541-484-5105
Mailing address:
  • Phone: 541-484-6133
  • Fax: 541-484-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD12018
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier192245
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MRS. DIANE L. KINTIGH
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 541-484-6133