Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 013283 | NY |
NPI | 1992389746 |
---|---|
Provider Name | George Swearington |
First Address | Santa Fe, NM 87508-8758 |
Second Address | San Francisco, CA 94109-5996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2021 |
Last Update Date | 07/05/2021 |