Provider Demographics
NPI:1346265675
Name:SWANSON, JAY V (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:V
Last Name:SWANSON
Suffix:
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:PO BOX 7060
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7060
Mailing Address - Country:US
Mailing Address - Phone:480-576-2409
Mailing Address - Fax:480-718-1301
Practice Address - Street 1:6820 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3705
Practice Address - Country:US
Practice Address - Phone:480-718-1285
Practice Address - Fax:480-718-1301
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ501917Medicaid
AZH11941Medicare UPIN
AZ501917Medicaid