Healthcare Provider Details

I. General information

NPI: 1841284429
Provider Name (Legal Business Name): FORREST SWAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

617 W CLAIREMONT AVE
EAU CLAIRE WI
54701-6223
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-9000
  • Fax:
Mailing address:
  • Phone: 715-839-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD488904C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101054148
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberDR.0062448
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDR.0062448
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number23266-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: