Provider Demographics
NPI:1740488469
Name:SWANSON, TERRELL J (MD)
Entity type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:J
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T.
Other - Middle Name:JOHN
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10961 BURNT MILL RD
Mailing Address - Street 2:#828
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4654
Mailing Address - Country:US
Mailing Address - Phone:904-333-8605
Mailing Address - Fax:
Practice Address - Street 1:4311 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6123
Practice Address - Country:US
Practice Address - Phone:904-641-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65801207P00000X
OK25845208000000X
FLME111251207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics