Provider Demographics
NPI:1831483130
Name:BOSWELL, THOMAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3212 SW 89TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7957
Mailing Address - Country:US
Mailing Address - Phone:405-378-3300
Mailing Address - Fax:405-378-3993
Practice Address - Street 1:3212 SW 89TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7957
Practice Address - Country:US
Practice Address - Phone:405-378-3300
Practice Address - Fax:405-378-3993
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171851207Q00000X
OK28338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR180705Medicare UPIN