Provider Demographics
NPI:1225020282
Name:GASBARRA, DIANNE BREWER (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:BREWER
Last Name:GASBARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:STE 405
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:STE 405
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-292-5500
Practice Address - Fax:405-292-5505
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13952207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10002019OAMedicaid
OKP00149574OtherRAILROAD MEDICARE
C94955Medicare UPIN
OKP00149574OtherRAILROAD MEDICARE