Provider Demographics
NPI:1902831803
Name:SWYGERT, TRINA D (MD)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:D
Last Name:SWYGERT
Suffix:
Gender:F
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:PO BOX 269064
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9064
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-7977
Practice Address - Street 1:6908 E RENO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2128
Practice Address - Country:US
Practice Address - Phone:405-737-7000
Practice Address - Fax:405-869-1245
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100080470AMedicaid
OK249630904Medicare PIN
OK100080470AMedicaid