Provider Demographics
NPI:1538254248
Name:SWYER, MARK LEWIS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LEWIS
Last Name:SWYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 128TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6338
Mailing Address - Country:US
Mailing Address - Phone:425-337-5100
Mailing Address - Fax:425-745-3933
Practice Address - Street 1:210 128TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6338
Practice Address - Country:US
Practice Address - Phone:425-337-5100
Practice Address - Fax:425-745-3933
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19726207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017318Medicaid
WA080007381OtherRAILROAD MEDICARE
WAR23889OtherBLUE SHIELD
WAA06700Medicare UPIN
WA1017318Medicaid