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NPI Code Detail

MEDICARE: DR. DALE G SWANHOLM M.D.

MEDICARE: DR. DALE G SWANHOLM 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
1207Q00000XFamily Medicine PhysicianE5263TX

General Provider Information

NPI Number : 1730187444
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DALE G SWANHOLM M.D.
Provider Business Mailing Address
First Line : 2300 HIGHLAND VILLAGE RD
Second Line : STE 600
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-8102
Country : US
Telephone Number : 972-317-0331
Fax Number : 972-317-3811
Provider Business Practice Location Address
First Line : 2300 HIGHLAND VILLAGE RD
Second Line : STE 600
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-7148
Country : US
Telephone Number : 972-317-0331
Fax Number : 972-317-3811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 04/21/2021

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