Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 45064 | WI |
N | 208600000X | Surgeon | 45064 | WI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 45750 | CO |
NPI | 1215970926 |
---|---|
Provider Name | Matthew R Swelstad |
First Address | Grand Junction, CO 81506 |
Second Address | Grand Junction, CO 81506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 13/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08101027 | (05) | CO |