MEDICARE: SWAN GASTROENTEROLOGY, P.C.

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	207RG0100X	Gastroenterology Physician	38120	AZ

General Provider Information

NPI Number	:	1619368891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWAN GASTROENTEROLOGY, P.C.

Provider Business Mailing Address
First Line	:	1505 N SWAN RD
Second Line	:	121
City	:	TUCSON
State	:	AZ
Zip	:	85712-4044
Country	:	US
Telephone Number	:	520-795-3090
Fax Number	:	520-795-3586

Provider Business Practice Location Address
First Line	:	1505 N SWAN RD
Second Line	:	121
City	:	TUCSON
State	:	AZ
Zip	:	85712-4044
Country	:	US
Telephone Number	:	520-795-3090
Fax Number	:	520-795-3586

Authorized Official
Title or Position	:	OWNER
Name	:	FADI DEEB
Credential	:	MD
Telephone Number	:	520-795-3090

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/18/2020

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