Healthcare Provider Details

I. General information

NPI: 1235491994
Provider Name (Legal Business Name): JESSE SCOTT SWIFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 E RIDGELINE DR STE 100
SOUTH OGDEN UT
84405-4977
US

IV. Provider business mailing address

1493 E RIDGELINE DR STE 100
SOUTH OGDEN UT
84405-4947
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1149
  • Fax: 801-399-0248
Mailing address:
  • Phone: 801-399-1149
  • Fax: 801-399-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR73211
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2016-0492
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11678583-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: