Provider Demographics
NPI:1972602050
Name:SWAFFORD, THOMAS A (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:SWAFFORD
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 1:1301 W SIXTH STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-372-2390
Mailing Address - Fax:405-742-5706
Practice Address - Street 1:1301 W SIXTH STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-372-2390
Practice Address - Fax:405-742-5706
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17951207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
249609501OtherMEDICARE PIN
C78451Medicare UPIN
900522352Medicare ID - Type UnspecifiedGROUP