Healthcare Provider Details

I. General information

NPI: 1245296813
Provider Name (Legal Business Name): GARY D SWAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 306
NAPLES FL
34102-5878
US

IV. Provider business mailing address

PO BOX 26067
SALT LAKE CITY UT
84126-0067
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0340
  • Fax: 239-624-0341
Mailing address:
  • Phone: 239-624-0400
  • Fax: 239-624-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL1474
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME106974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: