Provider Demographics
NPI:1962409904
Name:SWANSON, WILLIAM K III (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:SWANSON
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1746
Mailing Address - Country:US
Mailing Address - Phone:814-455-1311
Mailing Address - Fax:814-455-1312
Practice Address - Street 1:306 W 11TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1746
Practice Address - Country:US
Practice Address - Phone:814-455-1311
Practice Address - Fax:814-455-1312
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05008816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015557440006Medicaid
G22880Medicare UPIN
PA730139Medicare PIN