Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 83-316 | NM |
NPI | 1356337893 |
---|---|
Provider Name | Gaylord V Swan |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Espanola, NM 87532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 14/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25163 | (05) | NM |
C65310 | (02) |