Provider Demographics
NPI:1639158157
Name:SWANSON, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LATOUCHE
Mailing Address - Street 2:#250
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4261
Mailing Address - Country:US
Mailing Address - Phone:907-561-1530
Mailing Address - Fax:907-561-2611
Practice Address - Street 1:3500 LATOUCHE
Practice Address - Street 2:#250
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-1530
Practice Address - Fax:907-561-2611
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3078207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0000WCRCXOtherMCARE GROUP #
AKMD3078Medicaid
A05746Medicare UPIN
AKMD3078Medicaid