Provider Demographics
NPI:1306842406
Name:SWAYZE, DONALD C (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:SWAYZE
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:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-0019
Mailing Address - Country:US
Mailing Address - Phone:573-486-1193
Mailing Address - Fax:573-486-0910
Practice Address - Street 1:134 W 6TH ST
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1018
Practice Address - Country:US
Practice Address - Phone:573-486-5711
Practice Address - Fax:573-486-3827
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-02-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
KS0529283208600000X
MO2001011437208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO591257506Medicaid
KS100396790BMedicaid
KS100396790BMedicaid
MO591257506Medicaid
MO268602Medicare Oscar/Certification