MEDICARE: MR. MAX BRIAN SWENSON JR. PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA15	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970021922	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033100268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAX BRIAN SWENSON JR. PA-C

Provider Business Mailing Address
First Line	:	9641 S. SANDUSKY
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-4812
Country	:	US
Telephone Number	:	918-294-4779
Fax Number	:	918-294-4769

Provider Business Practice Location Address
First Line	:	8801 S. 101ST EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133
Country	:	US
Telephone Number	:	918-294-6911
Fax Number	:	918-294-4579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	12/22/2011

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Directions to “ MR. MAX BRIAN SWENSON JR. PA-C” Practice Location

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