Provider Demographics
NPI:1336193606
Name:SWANSON, DONALD FREDERICK II (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FREDERICK
Last Name:SWANSON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3001 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2544
Mailing Address - Country:US
Mailing Address - Phone:239-433-4014
Mailing Address - Fax:239-481-6247
Practice Address - Street 1:3001 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2544
Practice Address - Country:US
Practice Address - Phone:405-756-1414
Practice Address - Fax:405-756-1162
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272158900Medicaid
U4783AMedicare ID - Type Unspecified
FL272158900Medicaid