Provider Demographics
NPI:1053381889
Name:SWINDLE, JEREMY S (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:S
Last Name:SWINDLE
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:1000 N PROVIDENCE DR STE 210
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7582
Practice Address - Country:US
Practice Address - Phone:503-537-5900
Practice Address - Fax:503-537-5900
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26686207Q00000X
MO2004022191207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028333Medicaid
OR028333Medicaid
MOI45323Medicare UPIN
ORI45323Medicare UPIN