Basic Information
| Provider Information | |||||||||
| NPI: | 1386134641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWOFFORD | ||||||||
| FirstName: | DEVON | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHILDRENS PL CB 8116 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546148 | ||||||||
| FaxNumber: | 3144544633 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PL CB 8116 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546148 | ||||||||
| FaxNumber: | 3144544633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2018 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 2021012583 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.