Provider Demographics
NPI:1376704445
Name:BRISTOL SWANSON, AMANDA ERIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ERIN
Last Name:BRISTOL SWANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVENUE
Mailing Address - Street 2:STE. 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4488
Mailing Address - Country:US
Mailing Address - Phone:253-722-1540
Mailing Address - Fax:
Practice Address - Street 1:1102 SOUTH I STREET
Practice Address - Street 2:DOWNTOWN CLINIC - COMMUNITY HEALTH CARE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-597-3813
Practice Address - Fax:253-597-3815
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60213498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine