Provider Demographics
NPI:1841284429
Name:SWAN, FORREST JR (MD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:
Last Name:SWAN
Suffix:JR
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 1:617 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6223
Mailing Address - Country:US
Mailing Address - Phone:715-839-5175
Mailing Address - Fax:
Practice Address - Street 1:1086 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4305
Practice Address - Country:US
Practice Address - Phone:814-534-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054148174400000X
PAMD488904C207RH0003X
WI23266-20207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005811422Medicaid
VA243177OtherANTHEM BC/BS PROVIDER #
VAB26795Medicare UPIN
VA243177OtherANTHEM BC/BS PROVIDER #
VA900000027Medicare ID - Type UnspecifiedMEDICARE INDIV. PROV. #