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Individual
BRIAN WILLIS SWANTON
Active
Individual
BRIAN WILLIS SWANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301035130
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0348293
BLUE CROSS BLUE SHIELD MI
MI
05
—
2817978
—
MI
01
—
382376508
TAX IDENTIFICATION
MI
01
—
BS035130
STATE LICENSE MI
MI
Enumeration date
08/29/2006
Last updated
07/08/2007
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