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General NPI Number Information
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NPI Number | 1760720668
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Entity Type | Organization
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Legal Business Name | STILLWATER HISTOLOGY LLC
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 1301 W. 6TH ST SUITE 106
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-372-2390
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Fax | 405-742-5706
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Provider Business Mailing Address
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Address Line | 1301 W. 6TH ST SUITE 106
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-372-2390
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Fax | 405-742-5706
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Authorized Official
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Title or Position | CO-OWNER
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Name | THOMAS A. SWAFFORD
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Credential | M.D.
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Telephone | 405-372-2390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | OK
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