Provider Demographics
NPI:1609850510
Name:SWANSON, GERALD ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ERNEST
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7514 LANDAU DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2312
Mailing Address - Country:US
Mailing Address - Phone:952-303-6726
Mailing Address - Fax:952-303-6727
Practice Address - Street 1:7514 LANDAU DR
Practice Address - Street 2:SUITE 315
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55438-2312
Practice Address - Country:US
Practice Address - Phone:952-303-6726
Practice Address - Fax:952-303-6727
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN17405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA96011Medicare UPIN
MN110003853Medicare ID - Type Unspecified