MEDICARE: RUSSELL E SWANN M.D.

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	207W00000X	Ophthalmology Physician	E5626	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DC9834	OTHER	TX	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	742336149	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1841293016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL E SWANN M.D.

Provider Business Mailing Address
First Line	:	201 LONDONDERRY DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7902
Country	:	US
Telephone Number	:	254-772-4499
Fax Number	:	254-772-4436

Provider Business Practice Location Address
First Line	:	201 LONDONDERRY DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7902
Country	:	US
Telephone Number	:	254-772-4499
Fax Number	:	254-772-4436

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/11/2011

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Directions to “ RUSSELL E SWANN M.D.” Practice Location

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