Provider Demographics
NPI:1215970926
Name:SWELSTAD, MATTHEW R (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:SWELSTAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2515 FORESIGHT CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1018
Mailing Address - Country:US
Mailing Address - Phone:970-245-2400
Mailing Address - Fax:970-242-9092
Practice Address - Street 1:2515 FORESIGHT CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1018
Practice Address - Country:US
Practice Address - Phone:970-242-8177
Practice Address - Fax:970-255-3558
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-01-29
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Provider Licenses
StateLicense IDTaxonomies
CODR.00457502086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08101027Medicaid
COC809900Medicare PIN