Provider Demographics
NPI:1851443808
Name:DOUGLAS G. SWANSON MD PC
Entity Type:Organization
Organization Name:DOUGLAS G. SWANSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-635-7288
Mailing Address - Street 1:265 PARKSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3141
Mailing Address - Country:US
Mailing Address - Phone:719-635-7288
Mailing Address - Fax:719-473-6113
Practice Address - Street 1:265 PARKSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3141
Practice Address - Country:US
Practice Address - Phone:719-635-7288
Practice Address - Fax:719-473-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01247899Medicaid
COD14497Medicare UPIN
CO01247899Medicaid