Provider Demographics
NPI:1124408299
Name:SWANSON, JON (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-0027
Mailing Address - Country:US
Mailing Address - Phone:712-304-2282
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 27
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-0027
Practice Address - Country:US
Practice Address - Phone:712-304-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019299207Q00000X
NE2335207Q00000X
IADO-06208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine