Healthcare Provider Details

I. General information

NPI: 1134162001
Provider Name (Legal Business Name): JOHN FREDERICK SWETLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

IV. Provider business mailing address

442 DOMINICA CT
REDDING CA
96003-2814
US

V. Phone/Fax

Practice location:
  • Phone: 503-543-8402
  • Fax: 503-543-8402
Mailing address:
  • Phone: 530-243-0440
  • Fax: 530-243-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD19431
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier075494
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: