Provider Demographics
NPI:1467445007
Name:SWANSON, JACK J (DO, PHD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:J
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:J
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3014
Mailing Address - Street 2:1215 DUFF AVE MCFARLAND CLINIC, PC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4400
Mailing Address - Fax:515-239-4446
Practice Address - Street 1:1015 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5733
Practice Address - Country:US
Practice Address - Phone:515-239-4414
Practice Address - Fax:515-239-4786
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3498207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology