Provider Demographics
NPI:1598898363
Name:SWOBODA, PAUL RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:SWOBODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26028
Mailing Address - Street 2:CLINICIAN SERVICES / CREDENTIALING
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-262-7963
Mailing Address - Fax:505-232-1627
Practice Address - Street 1:9101 MONTGOMERY BLVD., NE
Practice Address - Street 2:MONTGOMERY EAST FAMILY MEDICINE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-275-4288
Practice Address - Fax:505-275-4203
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT356087-1205207Q00000X
MA79259207Q00000X
NMMD2019-0734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF99984Medicare UPIN
UT005581701Medicare PIN
UTPRA03276Medicaid