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General NPI Number Information
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NPI Number | 1285816850
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Entity Type | Organization
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Legal Business Name | RUSSELL E SWANN M.D. PA
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 201 LONDONDERRY DR
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City | WACO
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State | TX
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Zip | 76712-7902
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Country | US
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Telephone | 254-772-4499
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Fax | 254-772-4436
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Provider Business Mailing Address
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Address Line | 201 LONDONDERRY DR
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City | WACO
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State | TX
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Zip | 76712-7902
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Country | US
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Telephone | 254-772-4499
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Fax | 254-772-4436
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Authorized Official
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Title or Position | INSURANCE BILLING
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Name | SHAYE J WOOTEN
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Credential |
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Telephone | 254-772-4499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E5626
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License Number State | TX
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