Healthcare Provider Details

I. General information

NPI: 1538379367
Provider Name (Legal Business Name): DIANNE B GASBARRA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD SUITE 405
OKLAHOMA CITY OK
73120-9350
US

IV. Provider business mailing address

4200 W MEMORIAL RD SUITE 405
OKLAHOMA CITY OK
73120-9350
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-0210
  • Fax: 405-749-8311
Mailing address:
  • Phone: 405-749-0210
  • Fax: 405-749-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number13952
License Number StateOK

VIII. Authorized Official

Name: DIANNE GASBARRA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 405-749-0210