Basic Information
| Provider Information | |||||||||
| NPI: | 1598898363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWOBODA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26028 | ||||||||
| Address2: | CLINICIAN SERVICES / CREDENTIALING | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627963 | ||||||||
| FaxNumber: | 5052321627 | ||||||||
| Practice Location | |||||||||
| Address1: | 9101 MONTGOMERY BLVD., NE | ||||||||
| Address2: | MONTGOMERY EAST FAMILY MEDICINE | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052754288 | ||||||||
| FaxNumber: | 5052754203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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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 | 207Q00000X | 356087-1205 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 79259 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2019-0734 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.