MEDICARE: SWENSON MEDICAL PLLC

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	207Q00000X	Family Medicine Physician	OS10630	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS10630	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1740627769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWENSON MEDICAL PLLC

Provider Business Mailing Address
First Line	:	230 BATH CLUB BLVD S
Second Line	:
City	:	NORTH REDINGTON BEACH
State	:	FL
Zip	:	33708-1532
Country	:	US
Telephone Number	:	727-656-0722
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 BATH CLUB BLVD S
Second Line	:
City	:	NORTH REDINGTON BEACH
State	:	FL
Zip	:	33708-1532
Country	:	US
Telephone Number	:	727-656-0722
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DAVID SWENSON
Credential	:
Telephone Number	:	727-656-0722

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	07/25/2019

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