Provider Demographics
NPI:1033100268
Name:SWENSON, MAX BRIAN JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:BRIAN
Last Name:SWENSON
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9641 S. SANDUSKY
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4812
Mailing Address - Country:US
Mailing Address - Phone:918-294-4779
Mailing Address - Fax:918-294-4769
Practice Address - Street 1:8801 S. 101ST EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-294-6911
Practice Address - Fax:918-294-4579
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2011-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA15363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100110300BMedicaid
OK970021922OtherRAILROAD MEDICARE
OKS39469Medicare UPIN