Provider Demographics
NPI:1407291420
Name:SWANN, FORREST BEAU (MD)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:BEAU
Last Name:SWANN
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 1:201 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7931
Mailing Address - Country:US
Mailing Address - Phone:254-772-4499
Mailing Address - Fax:254-772-4436
Practice Address - Street 1:201 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7931
Practice Address - Country:US
Practice Address - Phone:254-772-4499
Practice Address - Fax:254-772-4436
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130916207W00000X
TXR5656207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020669700Medicaid