1477653228 NPI number — DOUGLAS J SWANK D.O.

Table of content: DOUGLAS J SWANK D.O. (NPI 1477653228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477653228 NPI number — DOUGLAS J SWANK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANK
Provider First Name:
DOUGLAS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477653228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99514-0349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-274-7977
Provider Business Mailing Address Fax Number:
907-274-7901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 DEBARR RD
Provider Second Line Business Practice Location Address:
SUITE 390
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-274-7977
Provider Business Practice Location Address Fax Number:
907-274-7901
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  6958 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0208565 . This is a "WASHINTON STATE D.O.L." identifier . This identifiers is of the category "OTHER".
  • Identifier: MD6958 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00004360 . This is a "RAILROAD MC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com