Provider Demographics
NPI:1992808323
Name:SWANSON, KEITH ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ROBERT
Last Name:SWANSON
Suffix:
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 1:4 EAST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022
Mailing Address - Country:US
Mailing Address - Phone:712-243-5005
Mailing Address - Fax:712-243-5005
Practice Address - Street 1:4 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1566
Practice Address - Country:US
Practice Address - Phone:712-243-5005
Practice Address - Fax:712-243-5005
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA00086Medicare UPIN