Doctor Name: | BRIAN WILLIS SWANTON |
NPI Number: | 1972612547 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301035130 |
Business Practice Address: | 4294 Laurel Dr Lake Odessa, MI - 488499423 |
Business Phone Number: | 6163747660 |
Business Fax Number: | 6163740270 |
Mailing Address: | 4294 Laurel Dr, P.o. Box 578 LAKE ODESSA |
State: | MI |
Postal Code: | 488499423 |
Phone Number: | 6163747660 |
Fax Number: | 6163740270 |
NPI Enumeration Date: | 08/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4301035130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |