Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | IL | |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | IL |
NPI | 1609989334 |
---|---|
Provider Name | Dr. Benjamin G Swartout |
First Address | Los Angeles, CA 90067-2001 |
Second Address | Los Angeles, CA 90067-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I69452 | UPIN (01) |