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General NPI Number Information
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NPI Number | 1861624868
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Entity Type | Individual
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Provider Name | ZACHARY SWANSON PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 215 E QUINCY ST STE 604
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City | SAN ANTONIO
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State | TX
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Zip | 78215-2019
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Country | US
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Telephone | 210-798-4311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5730
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City | BELFAST
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State | ME
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Zip | 04915-5700
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Country | US
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Telephone | 888-402-7256
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA12393
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA2329
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License Number State | TN
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