Provider Demographics
NPI:1467075655
Name:BRESLER, RICHARD MARK (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARK
Last Name:BRESLER
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BELK BOULEVARD
Mailing Address - Street 2:BAPTIST MEMORIAL HOSPITAL- NORTH MISSISSIPPI
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5242
Mailing Address - Country:US
Mailing Address - Phone:662-636-1000
Mailing Address - Fax:662-636-1670
Practice Address - Street 1:1100 BELK BOULEVARD
Practice Address - Street 2:BAPTIST MEMORIAL HOSPITAL- NORTH MISSISSIPPI
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5242
Practice Address - Country:US
Practice Address - Phone:662-636-1000
Practice Address - Fax:662-636-1670
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2022-07-13
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-06-13
Provider Licenses
StateLicense IDTaxonomies
MSG6G53W390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program