Provider Demographics
NPI:1265671093
Name:DRESSLER, BRENT ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:DRESSLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 S 109TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-392-1400
Mailing Address - Fax:918-392-1488
Practice Address - Street 1:4802 S 109TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5822
Practice Address - Country:US
Practice Address - Phone:918-392-1400
Practice Address - Fax:918-392-1488
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017993207X00000X
PAOS016330207X00000X
TXQ1396207X00000X
OK6087207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200681560AMedicaid
PA2891115OtherHIGHMARK BLUE SHIELD
TX340842901Medicaid
PA1623105OtherGATEWAY
PA102826290Medicaid
PA420158OtherUPMC
TX340842901Medicaid
PA286176FLTMedicare PIN
OK540727YPF1Medicare PIN