=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497012009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROLAND SWEATMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 07/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 STANLEY ST
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-721-0115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 SWAMP CREEK LOOP ROAD
-----------------------------------------------------
City | TROUT CREEK
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59874-9552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-827-8787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 4232
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------