Provider Demographics
NPI:1942419643
Name:BAZZLE, CHERYL C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:C
Last Name:BAZZLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 WHITESPORT DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-880-9345
Mailing Address - Fax:256-880-3961
Practice Address - Street 1:333 WHITESPORT DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-880-9345
Practice Address - Fax:256-880-3961
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23017174400000X
AL00023017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH41291Medicare UPIN