Healthcare Provider Details

I. General information

NPI: 1942311584
Provider Name (Legal Business Name): JOHN T SWISHER IV DO, CAQ, FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N EISENHOWER AVE
MASON CITY IA
50401-1552
US

IV. Provider business mailing address

621 S ILLINOIS AVE
MASON CITY IA
50401-5405
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-5911
  • Fax: 641-428-5985
Mailing address:
  • Phone: 641-428-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number8418
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number03815
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: