Provider Demographics
NPI:1477769917
Name:SWANSON, RANDY FERRER (SUBMARINE IDC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:FERRER
Last Name:SWANSON
Suffix:
Gender:M
Credentials:SUBMARINE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-328 HOOMALULE PLACE
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:904-710-3267
Mailing Address - Fax:
Practice Address - Street 1:USS CHARLOTTE (SSN 766)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96662-2422
Practice Address - Country:US
Practice Address - Phone:808-284-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman