Provider Demographics
NPI:1801868633
Name:SWANSON, MICHAEL GRIFFIN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GRIFFIN
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:GRIFFIN
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:45450 PEACOCK PL
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4828
Mailing Address - Country:US
Mailing Address - Phone:619-261-8611
Mailing Address - Fax:
Practice Address - Street 1:MCRD BRANCH HEALTH CLINIC
Practice Address - Street 2:35000 GUADALCANAL AVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5002
Practice Address - Country:US
Practice Address - Phone:619-524-4079
Practice Address - Fax:619-521-0852
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 9658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine