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General NPI Number Information
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NPI Number | 1447449640
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Entity Type | Organization
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Legal Business Name | GEOFFREY N SWANSON MD PA
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 2321 E GALA ST SUITE 2
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City | MERIDIAN
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State | ID
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Zip | 83642-7692
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Country | US
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Telephone | 208-288-2255
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Fax | 208-288-1535
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Provider Business Mailing Address
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Address Line | 2321 E GALA ST SUITE 2
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City | MERIDIAN
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State | ID
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Zip | 83642-6351
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Country | US
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Telephone | 208-288-2255
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Fax | 208-288-1535
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEOFFREY N SWANSON
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Credential | ND
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Telephone | 208-288-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | M6536
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License Number State | ID
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