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General NPI Number Information
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NPI Number | 1689013005
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Entity Type | Individual
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Provider Name | JESSICA MARIE FAZENDIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 825 NE 10TH ST STE 4G
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5417
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Country | US
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Telephone | 405-271-5789
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Fax | 405-271-1643
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Provider Business Mailing Address
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Address Line | PO BOX 55310
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City | BIRMINGHAM
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State | AL
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Zip | 35255-5310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 38362
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 45139
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License Number State | OK
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