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General NPI Number Information
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NPI Number | 1285697318
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Entity Type | Individual
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Provider Name | DOUGLAS GERALD SWANSON MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 455 E PIKES PEAK AVE STE 105
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3672
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Country | US
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Telephone | 719-635-7288
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Fax | 719-473-6113
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Provider Business Mailing Address
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Address Line | 455 E PIKES PEAK AVE STE 105
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3672
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Country | US
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Telephone | 719-635-7288
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Fax | 719-473-6113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24789
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License Number State | CO
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