Provider Demographics
NPI:1427032879
Name:SWENSON, CRAIG (PHYSICAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:SWENSON
Suffix:
Gender:M
Credentials:PHYSICAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N ED CAREY DR
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8200
Mailing Address - Country:US
Mailing Address - Phone:956-428-5522
Mailing Address - Fax:956-421-2759
Practice Address - Street 1:500 E RIDGE RD
Practice Address - Street 2:SUITE #300
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1506
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-421-2759
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D7960Medicare ID - Type Unspecified
TXQ44174Medicare UPIN