Provider Demographics
NPI:1215112578
Name:SWAN, KEVIN ROY (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROY
Last Name:SWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SOUTHCITY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5718
Mailing Address - Country:US
Mailing Address - Phone:337-981-6430
Mailing Address - Fax:337-981-9134
Practice Address - Street 1:214 SOUTHCITY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5718
Practice Address - Country:US
Practice Address - Phone:337-981-6430
Practice Address - Fax:337-981-9134
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136354207W00000X
LAMD.203713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1215112578OtherBLUE CROSS BLUE SHIELD
LA1215112578OtherPPO PLUS
LA1215112578OtherAMERICAN LIFECARE
LA1215112578OtherOFFICE OF GROUP BENEFITS
LA1215112578OtherGILSBAR 360
LA1215112578OtherCOVENTRY
LA1215112578OtherUNITED HEALTHCARE
LA1215112578OtherBESTCARE
LA1215112578OtherVERITY
LA1215112578OtherPHCS
LA1215112578OtherPHCS
LA1215112578OtherUNITED HEALTHCARE