Provider Demographics
NPI:1386134641
Name:SWOFFORD, DEVON PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:PATRICK
Last Name:SWOFFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 CHILDRENS PL CB 8116
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-454-6148
Mailing Address - Fax:314-454-4633
Practice Address - Street 1:1 CHILDRENS PL CB 8116
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-454-6148
Practice Address - Fax:314-454-4633
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2024-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2021012583208000000X
390200000X
WAOP615303162080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program