Healthcare Provider Details

I. General information

NPI: 1326012618
Provider Name (Legal Business Name): STEPHEN M. SWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN M. SWAN PA

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BALSAM AVE
BOULDER CO
80304-3404
US

IV. Provider business mailing address

PO BOX 173894
DENVER CO
80217-3894
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-2037
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPAL 1917
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0001917
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: