Provider Demographics
NPI:1396880324
Name:SWANSON, BARRY (PA)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-0790
Mailing Address - Country:US
Mailing Address - Phone:559-876-6703
Mailing Address - Fax:559-876-6705
Practice Address - Street 1:1209 WHITLEY AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2327
Practice Address - Country:US
Practice Address - Phone:559-899-2502
Practice Address - Fax:559-992-3997
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 12789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant