Healthcare Provider Details

I. General information

NPI: 1790724847
Provider Name (Legal Business Name): MICHAEL RICHARD SWINYER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 S 1100 E SUITE 310
SALT LAKE CITY UT
84124-1213
US

IV. Provider business mailing address

3920 S 1100 E SUITE 310
SALT LAKE CITY UT
84124-1213
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-8841
  • Fax:
Mailing address:
  • Phone: 801-266-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number57383141206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: