Healthcare Provider Details

I. General information

NPI: 1053424952
Provider Name (Legal Business Name): MICHAEL CLIFFORD SWANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DOUG BAKER BLVD
BIRMINGHAM AL
35242-2013
US

IV. Provider business mailing address

2162 BROOK HIGHLAND RDG
BIRMINGHAM AL
35242-5870
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-3933
  • Fax: 205-408-3934
Mailing address:
  • Phone: 205-999-5402
  • Fax: 205-991-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14185
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: