Provider Demographics
NPI:1679593719
Name:SWANNER, JASON CLINT (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CLINT
Last Name:SWANNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 59449
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35259-9449
Mailing Address - Country:US
Mailing Address - Phone:205-876-8988
Mailing Address - Fax:205-679-8440
Practice Address - Street 1:2010 PATTON CHAPEL RD STE 101
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5783
Practice Address - Country:US
Practice Address - Phone:205-876-8988
Practice Address - Fax:205-679-8440
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22866207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051513887Medicaid
ALH63424OtherHEALTHSPRING OF ALABAMA
AL051513887OtherBLUE CROSS
AL926035OtherBLOCK VISION
AL127525Medicaid
AL051513887OtherBLUE CROSS
AL926035OtherBLOCK VISION