Provider Demographics
NPI:1861485054
Name:SWANN, GARY F (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:SWANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:959 ILLINOIS AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1743
Mailing Address - Country:US
Mailing Address - Phone:419-893-5588
Mailing Address - Fax:419-893-6800
Practice Address - Street 1:959 ILLINOIS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1743
Practice Address - Country:US
Practice Address - Phone:419-893-5588
Practice Address - Fax:419-893-6800
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34004478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0731917Medicaid
MI113083633Medicaid
OH0731917Medicaid