Provider Demographics
NPI:1942239199
Name:BRAZEAL, TIFFANY GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:GAIL
Last Name:BRAZEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268986
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8986
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-7977
Practice Address - Street 1:9720 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6315
Practice Address - Country:US
Practice Address - Phone:405-280-7546
Practice Address - Fax:405-772-8674
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK27705207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology