Provider Demographics
NPI:1053305649
Name:SWAIN, RONNIE EVERETT SR (MD)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:EVERETT
Last Name:SWAIN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-473-1900
Mailing Address - Fax:251-470-8943
Practice Address - Street 1:2880 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2457
Practice Address - Country:US
Practice Address - Phone:251-473-1900
Practice Address - Fax:251-470-8943
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006927207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4006768OtherAETNA PROVIDER #
AL51528797OtherBLUE CROSS OF ALABAMA PIN
AL51512113OtherBLUE CROSS AL PROVIDER #
ALC71301OtherHEALTHSPRING PROVIDER #
AL51034510OtherBLUE CROSS PROVIDER #
AL51528797OtherBLUE CROSS OF ALABAMA PIN
AL51528797Medicare PIN