Provider Demographics
NPI:1225008881
Name:SWANN, JAMES HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HOWARD
Last Name:SWANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 IRISH IVY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6751
Mailing Address - Country:US
Mailing Address - Phone:417-291-2104
Mailing Address - Fax:
Practice Address - Street 1:4474 IRISH IVY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6751
Practice Address - Country:US
Practice Address - Phone:417-291-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35103207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE66070Medicare UPIN
KS046192Medicare ID - Type Unspecified