Provider Demographics
NPI:1679548648
Name:SWANSON, GENE EARL (MD)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:EARL
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6076
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:507-625-5971
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19580207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115444C572OtherUCARE MN
MN41645SWOtherBCBS OF MN
MN410940705H015OtherTRICARE/WPS
MN0901559OtherMEDICA, MANKATO
MN200023457Medicare ID - Type UnspecifiedPALMETTO GBA, RR MC
MND75566Medicare UPIN
MN950002200Medicaid
MNHP18801OtherHEALTH PARTNERS
MN209000327Medicare ID - Type UnspecifiedMEDICARE
MN0900439OtherMEDICA, WASECA
MN983181004373OtherPREFERRED ONE