Healthcare Provider Details

I. General information

NPI: 1437371952
Provider Name (Legal Business Name): PBGHEZZI,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NW 21ST STREET
OKLAHOMA CITY OK
73103
US

IV. Provider business mailing address

310 NW 21ST STREET
OKLAHOMA CITY OK
73103
US

V. Phone/Fax

Practice location:
  • Phone: 405-308-1810
  • Fax:
Mailing address:
  • Phone: 405-308-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number3727
License Number StateOK

VIII. Authorized Official

Name: PAMELA GHEZZI
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 405-308-1810