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General NPI Number Information
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NPI Number | 1790979052
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Entity Type | Individual
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Provider Name | DAVID WILLIAM SWANSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 1622 29TH AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-2270
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Country | US
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Telephone | 612-718-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 29TH AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-2270
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Country | US
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Telephone | 612-543-2707
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 40170
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 40170
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License Number State | MN
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