Provider Demographics
NPI:1821290974
Name:SWANKE, WILLIAM ROY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROY
Last Name:SWANKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:
Other - Last Name:SWANKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15414 SMOKEY PT BLVD
Mailing Address - Street 2:339
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-5953
Mailing Address - Country:US
Mailing Address - Phone:360-387-9544
Mailing Address - Fax:360-387-8884
Practice Address - Street 1:15414 SMOKEY PT BLVD
Practice Address - Street 2:339
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-5953
Practice Address - Country:US
Practice Address - Phone:360-387-9544
Practice Address - Fax:360-387-8884
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM92292084N0400X
WAMD000292312084P0800X
CAG166332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16633OtherMEDICAL LICENSE
WAMD00029231OtherMD
WA1072263Medicaid
WAMD00029231OtherMD
WA1072263Medicaid