Individual
DAVIS M SWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 W 5TH ST, SHERIDAN, WY 82801-2705
(307) 672-7874
Mailing address
PO BOX 767, SHERIDAN, WY 82801-0767
(307) 674-5123
(307) 674-5230
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
3149A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020241
MONTANA MEDICAID PIN
MT
05
—
103886900
—
WY
01
—
302093
BCBS OF WYO PIN
WY
Enumeration date
02/06/2007
Last updated
05/09/2008
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