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General NPI Number Information
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NPI Number | 1598898363
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Entity Type | Individual
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Provider Name | PAUL RICHARD SWOBODA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 9101 MONTGOMERY BLVD., NE MONTGOMERY EAST FAMILY MEDICINE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111
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Country | US
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Telephone | 505-275-4288
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Fax | 505-275-4203
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Provider Business Mailing Address
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Address Line | PO BOX 26028 CLINICIAN SERVICES / CREDENTIALING
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6028
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Country | US
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Telephone | 505-262-7963
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Fax | 505-232-1627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 356087-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 79259
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2019-0734
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License Number State | NM
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