Provider Demographics
NPI:1336124742
Name:SWAN, JOHN L II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:SWAN
Suffix:II
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 1:2752 ZELDA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2694
Mailing Address - Country:US
Mailing Address - Phone:334-481-2800
Mailing Address - Fax:334-270-3375
Practice Address - Street 1:2752 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2694
Practice Address - Country:US
Practice Address - Phone:334-481-2800
Practice Address - Fax:334-270-3375
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000083593Medicaid
AL83593Medicare ID - Type Unspecified
AL000083593Medicaid