Provider Demographics
NPI:1740456680
Name:SWENSON, JONATHAN B (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 N 500 E
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2408
Mailing Address - Country:US
Mailing Address - Phone:435-716-2800
Mailing Address - Fax:435-716-2809
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:SUITE 130
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-716-2800
Practice Address - Fax:435-716-2809
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT8630155-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation