Provider Demographics
NPI:1902097587
Name:SWANSON, ELI A (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E ROOSEVELT ST FL ON3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4948
Mailing Address - Country:US
Mailing Address - Phone:602-344-5895
Mailing Address - Fax:602-344-0718
Practice Address - Street 1:2525 E. ROOSEVELT ST
Practice Address - Street 2:ORTHO CLINIC ON 3RD FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-344-5895
Practice Address - Fax:602-344-0718
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46479207XX0801X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma