Provider Demographics
NPI:1497756951
Name:SWANN, KARL WINSTON (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:WINSTON
Last Name:SWANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4410 MEDICAL DR
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6306
Mailing Address - Country:US
Mailing Address - Phone:210-614-2453
Mailing Address - Fax:210-614-4457
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:SUITE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6306
Practice Address - Country:US
Practice Address - Phone:210-614-2453
Practice Address - Fax:210-614-4457
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG9542207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038585801Medicaid
TX038585801Medicaid
B74541Medicare UPIN