Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 14281 | OK |
NPI | 1053378554 |
---|---|
Provider Name | Mr. Richard T Swenson |
First Address | Norman, OK 73072-6614 |
Second Address | Edmond, OK 73013-3041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100106950B | (05) | OK |
F04427 | (02) | OK |