Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 100372 | MO |
NPI | 1013904150 |
---|---|
Provider Name | Dr. John Scott Swango |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 08/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013904150 | (05) | MO |
203320700 | (05) | MO |
E41729 | (02) | |
MD100372 | STATE LICENSE (01) | MO |