Provider Demographics
NPI:1295936300
Name:SWINEFORD, JASON ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:SWINEFORD
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 1:3005 DANIELS RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-7002
Mailing Address - Country:US
Mailing Address - Phone:407-654-8186
Mailing Address - Fax:407-877-7956
Practice Address - Street 1:3005 DANIELS RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-7002
Practice Address - Country:US
Practice Address - Phone:407-654-8186
Practice Address - Fax:407-877-7956
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000479000Medicaid
FLAL663ZMedicare PIN