Provider Demographics
NPI:1225719529
Name:SCHWARTZ, PHILIP RICHARD JR
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:RICHARD
Last Name:SCHWARTZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 S 76TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-6734
Mailing Address - Country:US
Mailing Address - Phone:918-694-7782
Mailing Address - Fax:
Practice Address - Street 1:8252 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-1646
Practice Address - Country:US
Practice Address - Phone:918-924-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician