Provider Demographics
NPI:1619150034
Name:CHERYL C. BAZZLE MD, PC
Entity Type:Organization
Organization Name:CHERYL C. BAZZLE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAZZLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-880-9345
Mailing Address - Street 1:333 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6454
Mailing Address - Country:US
Mailing Address - Phone:256-880-9345
Mailing Address - Fax:256-880-3961
Practice Address - Street 1:333 WHITESPORT DR SW
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6454
Practice Address - Country:US
Practice Address - Phone:256-880-9345
Practice Address - Fax:256-880-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ621OtherMEDICARE GROUP