Provider Demographics
NPI:1104825918
Name:SWANSON, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SWANSON
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 1:1417 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1715
Mailing Address - Country:US
Mailing Address - Phone:605-336-0517
Mailing Address - Fax:605-336-2874
Practice Address - Street 1:1417 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1715
Practice Address - Country:US
Practice Address - Phone:605-336-0517
Practice Address - Fax:605-336-2874
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5236207U00000X
MN47112207U00000X
IA35827207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97491Medicare UPIN