Individual
RUSSELL E SWANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 LONDONDERRY DR, WACO, TX 76712-7902
(254) 772-4499
(254) 772-4436
Mailing address
201 LONDONDERRY DR, WACO, TX 76712-7902
(254) 772-4499
(254) 772-4436
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
E5626
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110143801
—
TX
01
—
742336149
TAX ID
TX
01
—
DC9834
RR MEDICARE PIN
TX
Enumeration date
05/23/2005
Last updated
10/11/2011
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