Individual
JAY IVOR SWANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.D.
Contact information
Practice address
901 MEDICAL PARK DR, EFFINGHAM, IL 62401-2191
(217) 342-4444
(217) 347-8928
Mailing address
901 MEDICAL PARK DR, EFFINGHAM, IL 62401-2191
(217) 342-4444
(217) 347-8928
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019019384
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019019384
—
IL
Enumeration date
02/26/2008
Last updated
03/04/2013
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