Individual
MR. MAX BRIAN SWENSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8801 S. 101ST EAST AVE, TULSA, OK 74133
(918) 294-6911
(918) 294-4579
Mailing address
9641 S. SANDUSKY, TULSA, OK 74137-4812
(918) 294-4779
(918) 294-4769
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA15
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100110300B
—
OK
01
—
970021922
RAILROAD MEDICARE
OK
Enumeration date
11/05/2005
Last updated
12/22/2011
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