MEDICARE: DIANNE BREWER GASBARRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	13952	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00149574	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225020282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE BREWER GASBARRA MD

Provider Business Mailing Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	STE 405
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-292-5500
Fax Number	:	405-292-5505

Provider Business Practice Location Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	STE 405
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-292-5500
Fax Number	:	405-292-5505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/08/2012

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Directions to “ DIANNE BREWER GASBARRA MD” Practice Location

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