Provider Demographics
NPI:1386697415
Name:SWAINE, KENT ALAN (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:ALAN
Last Name:SWAINE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 PINTO LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9186
Mailing Address - Country:US
Mailing Address - Phone:702-483-2408
Mailing Address - Fax:702-942-4388
Practice Address - Street 1:2050 PINTO LANE
Practice Address - Street 2:STE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-233-3444
Practice Address - Fax:702-233-6998
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018525Medicaid
NV37506Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
NV002018525Medicaid