Healthcare Provider Details

I. General information

NPI: 1467445007
Provider Name (Legal Business Name): JACK J. SWANSON DO, PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY J SWANSON DO

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DUFF AVE
AMES IA
50010-5733
US

IV. Provider business mailing address

PO BOX 3014 1215 DUFF AVE MCFARLAND CLINIC, PC
AMES IA
50010-3014
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4414
  • Fax: 515-239-4786
Mailing address:
  • Phone: 515-239-4400
  • Fax: 515-239-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3498
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: