Provider Demographics
NPI:1740267020
Name:SWANSON, ANDREW JAMES (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 E PRATER WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434
Mailing Address - Country:US
Mailing Address - Phone:775-331-5200
Mailing Address - Fax:775-331-5202
Practice Address - Street 1:1959 E PRATER WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434
Practice Address - Country:US
Practice Address - Phone:775-331-5200
Practice Address - Fax:775-331-5202
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016639Medicaid
NV32523Medicare ID - Type Unspecified
G57687Medicare UPIN