Provider Demographics
NPI:1619368891
Name:SWAN GASTROENTEROLOGY, P.C.
Entity Type:Organization
Organization Name:SWAN GASTROENTEROLOGY, P.C.
Other - Org Name:CONSULTANTS IN GASTROENTEROLOGY, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-795-3090
Mailing Address - Street 1:1505 N SWAN RD
Mailing Address - Street 2:121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4044
Mailing Address - Country:US
Mailing Address - Phone:520-795-3090
Mailing Address - Fax:520-795-3586
Practice Address - Street 1:1505 N SWAN RD
Practice Address - Street 2:121
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4044
Practice Address - Country:US
Practice Address - Phone:520-795-3090
Practice Address - Fax:520-795-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38120207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty