Healthcare Provider Details

I. General information

NPI: 1083703177
Provider Name (Legal Business Name): DAVID LYN SWANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD
AIEA HI
96701-4713
US

IV. Provider business mailing address

PO BOX 25370
HONOLULU HI
96825-0370
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-6000
  • Fax:
Mailing address:
  • Phone: 808-536-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-12878
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: