Healthcare Provider Details

I. General information

NPI: 1891343752
Provider Name (Legal Business Name): MARGARET TARR DESHAZER MS, RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BROADWAY STE 303
EDMOND OK
73034-3706
US

IV. Provider business mailing address

20 E BLANCH AVE
EDMOND OK
73034-3633
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-6129
  • Fax:
Mailing address:
  • Phone: 405-822-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number703
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: