MEDICARE: KIRTLAND DANA SWAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	LA 013847	LA

General Provider Information

NPI Number	:	1609967900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRTLAND DANA SWAN M.D.

Provider Business Mailing Address
First Line	:	113 SAINT THOMAS ST STE A
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4575
Country	:	US
Telephone Number	:	337-235-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SAINT THOMAS ST STE A
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4575
Country	:	US
Telephone Number	:	337-235-7561
Fax Number	:	337-237-8666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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