Healthcare Provider Details

I. General information

NPI: 1851920243
Provider Name (Legal Business Name): CONNOR R. SWINFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S OSPREY AVE
SARASOTA FL
34239-3932
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-7760
  • Fax: 941-917-8805
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME166921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: