Basic Information
| Provider Information | |||||||||
| NPI: | 1831483130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSWELL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3212 SW 89TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731597957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053783300 | ||||||||
| FaxNumber: | 4053783993 | ||||||||
| Practice Location | |||||||||
| Address1: | 3212 SW 89TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731597957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053783300 | ||||||||
| FaxNumber: | 4053783993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2011 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD171851 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 28338 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.