Healthcare Provider Details

I. General information

NPI: 1235117813
Provider Name (Legal Business Name): CONRAD M SWARTZ M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 NW 25TH CT
VANCOUVER WA
98685-2036
US

IV. Provider business mailing address

12911 NW 25TH CT
VANCOUVER WA
98685-2036
US

V. Phone/Fax

Practice location:
  • Phone: 360-597-3754
  • Fax: 888-523-2128
Mailing address:
  • Phone: 360-597-3754
  • Fax: 888-523-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD27984
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00048916
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD27984
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD00048916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: