Provider Demographics
NPI:1467422790
Name:BRESLOFF, TOBIE L (MD)
Entity Type:Individual
Prefix:
First Name:TOBIE
Middle Name:L
Last Name:BRESLOFF
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 1:1725 E 19TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5437
Mailing Address - Country:US
Mailing Address - Phone:918-748-7560
Mailing Address - Fax:918-293-3128
Practice Address - Street 1:1725 E 19TH ST
Practice Address - Street 2:STE 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5437
Practice Address - Country:US
Practice Address - Phone:918-748-7560
Practice Address - Fax:918-293-3128
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14852174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100014090AMedicaid
OKP00016229OtherMEDICARE RAILROAD
OKOK400767OtherMEDICARE PTAN
OK244311901Medicare ID - Type Unspecified
OKC94718Medicare UPIN