Swanson, Jack Tracy

Swanson, Jack Tracy is an individual health care provider with primary practice located at 1215 Duff Ave , Ames IA 50010-3014. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Swanson, Jack Tracy can be contacted via phone (515) 239-4404.

Contact Information

Primary practice address
1215 Duff Ave Ames IA 50010-3014
Fax: (515) 239-4721
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 18404 Iowa

Profile Details

NPI number 1861483372
LBN Legal business name Swanson, Jack Tracy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2005
Last updated Aug 17th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861483372 NPPES
Iowa MEDICAID 0125757

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