Provider Demographics
NPI:1043774433
Name:SWINFORD, ERIC ALEXANDER (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALEXANDER
Last Name:SWINFORD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 GRANDVIEW PKWY APT 402
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2075
Mailing Address - Country:US
Mailing Address - Phone:256-609-7445
Mailing Address - Fax:
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8956
Practice Address - Country:US
Practice Address - Phone:256-609-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141563367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1407911787OtherNPI