Provider Demographics
NPI:1437121274
Name:SWANSON, JEFFERY ALLEN (DO, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ALLEN
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DO, FAAFP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4412 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4015
Mailing Address - Country:US
Mailing Address - Phone:940-257-8663
Mailing Address - Fax:940-515-9089
Practice Address - Street 1:1417 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4302
Practice Address - Country:US
Practice Address - Phone:940-222-5184
Practice Address - Fax:940-514-9089
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP1416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2944993-01Medicaid
TXTXB145323Medicare PIN