Healthcare Provider Details

I. General information

NPI: 1518129436
Provider Name (Legal Business Name): ADAM J SWISHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MAIN ST
GOWRIE IA
50543-7438
US

IV. Provider business mailing address

1800 MAIN ST
GOWRIE IA
50543-7438
US

V. Phone/Fax

Practice location:
  • Phone: 515-352-3891
  • Fax: 515-352-5422
Mailing address:
  • Phone: 515-352-3891
  • Fax: 515-352-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4140
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: