Provider Demographics
NPI:1053378554
Name:SWENSON, RICHARD T (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:T
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 RENAISSANCE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3041
Practice Address - Country:US
Practice Address - Phone:405-285-7500
Practice Address - Fax:405-285-7501
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14281207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106950BMedicaid
OKF04427Medicare UPIN
OKOK403756Medicare PIN
OK100106950BMedicaid