Provider Demographics
NPI:1215970959
Name:SWINNEY, AUDIE GRANVILLE (MD)
Entity type:Individual
Prefix:
First Name:AUDIE
Middle Name:GRANVILLE
Last Name:SWINNEY
Suffix:
Gender:M
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:P.O. BOX 339
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-0339
Mailing Address - Country:US
Mailing Address - Phone:918-652-2513
Mailing Address - Fax:918-652-7884
Practice Address - Street 1:28870 SOUTH DEWEY BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437
Practice Address - Country:US
Practice Address - Phone:918-652-2513
Practice Address - Fax:918-652-7884
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine