Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 4298 | AZ |
Y | 207Q00000X | Family Doctor | 4298 | AZ |
NPI | 1417927120 |
---|---|
Provider Name | Dr. Matthew Scott Swain |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 01/04/2010 |