Basic Information
| Provider Information | |||||||||
| NPI: | 1386697415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWAINE | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 S DURANGO DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891179186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024832408 | ||||||||
| FaxNumber: | 7029424388 | ||||||||
| Practice Location | |||||||||
| Address1: | 5380 S RAINBOW BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891181877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022333444 | ||||||||
| FaxNumber: | 7022336998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13917 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002018525 | 05 | NV | MEDICAID |