Provider Demographics
NPI:1912942566
Name:SWANSON, DARREN D (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:D
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 1:900 HILLIGOSS BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1542
Mailing Address - Country:US
Mailing Address - Phone:218-435-1133
Mailing Address - Fax:218-435-1302
Practice Address - Street 1:900 HILLIGOSS BLVD SE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1542
Practice Address - Country:US
Practice Address - Phone:218-435-1133
Practice Address - Fax:218-435-1302
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDA9071015608OtherPREFERRED ONE #
MN0106026OtherMEDICA #
MN18284Medicaid
MN767316OtherAMERICA'S PPO/ARAZ #
MN537080900Medicaid
MNHP19567OtherHEALTHPARTNERS #
MNMN100034OtherLHS #
MN11933OtherNDBS #
MN124246OtherUCARE #
MN2M276SWOtherMNBS #
MN537080900Medicaid
MN0106026OtherMEDICA #
MN080048120Medicare ID - Type UnspecifiedRR MEDICARE #