Provider Demographics
NPI:1407351828
Name:SWENSON, ERIC MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:SWENSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HAMILTON ST # 2
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4208
Mailing Address - Country:US
Mailing Address - Phone:801-971-1351
Mailing Address - Fax:
Practice Address - Street 1:290 BOWIE RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6712
Practice Address - Country:US
Practice Address - Phone:985-493-4990
Practice Address - Fax:985-493-4991
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA326820213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist