Provider Demographics
NPI:1043630759
Name:SWANSON, JAMES FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:SWANSON
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 1:2002 N COUNCIL AVE
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-8038
Mailing Address - Country:US
Mailing Address - Phone:405-485-4701
Mailing Address - Fax:405-485-3747
Practice Address - Street 1:2002 N COUNCIL AVE
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8038
Practice Address - Country:US
Practice Address - Phone:405-485-4701
Practice Address - Fax:405-485-3747
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30637207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200600990AMedicaid