Provider Demographics
NPI:1396802898
Name:SWANSON, ERIC (MD FACS FRCSC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD FACS FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11413 ASH
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-663-1030
Mailing Address - Fax:913-663-1032
Practice Address - Street 1:11413 ASH
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-663-1030
Practice Address - Fax:913-663-1032
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04230272086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000968OtherMEDICARE B
15267076OtherBCBS OF KC
KS0000968OtherMEDICARE B