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General NPI Number Information
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NPI Number | 1033100268
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Entity Type | Individual
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Provider Name | MAX BRIAN SWENSON JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/05/2005
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 8801 S. 101ST EAST AVE
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City | TULSA
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State | OK
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Zip | 74133
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Country | US
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Telephone | 918-294-6911
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Fax | 918-294-4579
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Provider Business Mailing Address
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Address Line | 9641 S. SANDUSKY
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City | TULSA
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State | OK
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Zip | 74137-4812
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Country | US
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Telephone | 918-294-4779
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Fax | 918-294-4769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA15
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License Number State | OK
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