Provider Demographics
NPI:1750661294
Name:SWENSON, GRANT R (DPM)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:R
Last Name:SWENSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 S RAINBOW BLVD
Mailing Address - Street 2:STE 318
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1877
Mailing Address - Country:US
Mailing Address - Phone:702-873-3556
Mailing Address - Fax:702-871-4190
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:STE 318
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1877
Practice Address - Country:US
Practice Address - Phone:702-873-3556
Practice Address - Fax:702-871-4190
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV2000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery