MEDICARE: DR. RAYMOND ELMER SWANSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	010304708	IN

General Provider Information

NPI Number	:	1518209592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND ELMER SWANSON MD

Provider Business Mailing Address
First Line	:	207 ISLAND VIEW DR
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-5213
Country	:	US
Telephone Number	:	574-533-0066
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 ISLAND VIEW DR
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-5213
Country	:	US
Telephone Number	:	574-533-0066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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