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NPI Code Detail

MEDICARE: DR. TIFFANY GAIL BRAZEAL M.D.

MEDICARE: DR. TIFFANY GAIL BRAZEAL M.D.
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
1207N00000XDermatology Physician27705OK

General Provider Information

NPI Number : 1942239199
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIFFANY GAIL BRAZEAL M.D.
Provider Business Mailing Address
First Line : PO BOX 268986
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73126-8986
Country : US
Telephone Number : 405-231-3857
Fax Number : 405-272-7977
Provider Business Practice Location Address
First Line : 9720 BROADWAY EXT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6315
Country : US
Telephone Number : 405-280-7546
Fax Number : 405-772-8674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 10/20/2014

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