Healthcare Provider Details

I. General information

NPI: 1215498316
Provider Name (Legal Business Name): MARTINA BREANN SWINGER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 MEDICAL DR
PECOS TX
79772-2251
US

IV. Provider business mailing address

2349 MEDICAL DR
PECOS TX
79772-2251
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-0565
  • Fax: 432-447-0422
Mailing address:
  • Phone: 432-447-3551
  • Fax: 432-447-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV2834
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: