Individual
DALE SWIMS
Active
Individual
DALE SWIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036133679
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036133679
—
IL
01
—
125057797
STATE LICENSE
IL
01
—
406120
MEDICARE PTAN FOR SCMG
IL
01
—
F400098252
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
08/30/2010
Last updated
10/30/2020
Update your record
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