Provider Demographics
NPI:1649556887
Name:SWINDALL, RAYVON M SR
Entity type:Individual
Prefix:MR
First Name:RAYVON
Middle Name:M
Last Name:SWINDALL
Suffix:SR
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 1:5017 CINDERELLA DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-8929
Mailing Address - Country:US
Mailing Address - Phone:405-401-0978
Mailing Address - Fax:
Practice Address - Street 1:4638 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3429
Practice Address - Country:US
Practice Address - Phone:405-595-9579
Practice Address - Fax:405-528-4674
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator