Healthcare Provider Details

I. General information

NPI: 1861577256
Provider Name (Legal Business Name): MARK SWANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 WEST MILLER STREET
ORLANDO FL
32806
US

IV. Provider business mailing address

102 W. PINELOCH AVE. SUITE 23
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1600
  • Fax:
Mailing address:
  • Phone: 407-481-7174
  • Fax: 407-481-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME49629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: