Provider Demographics
NPI:1720834773
Name:SWOOPE, EFREM ISAIAH (PA-C)
Entity type:Individual
Prefix:
First Name:EFREM
Middle Name:ISAIAH
Last Name:SWOOPE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 POLARIS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6090
Mailing Address - Country:US
Mailing Address - Phone:614-895-3344
Mailing Address - Fax:614-895-3795
Practice Address - Street 1:460 POLARIS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6090
Practice Address - Country:US
Practice Address - Phone:614-895-3344
Practice Address - Fax:614-895-3795
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009085RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant