Healthcare Provider Details

I. General information

NPI: 1437166600
Provider Name (Legal Business Name): ROBERT CHAD SWANSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3380
US

IV. Provider business mailing address

PO BOX 10
SPANISH FORK UT
84660-0010
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-7850
  • Fax:
Mailing address:
  • Phone: 866-898-7136
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6169952-1204
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier61699521201001
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 2
Identifier1437166600
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 3
Identifier61699521200001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBLUE CROSS PROVIDER NUMBE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: