Provider Demographics
NPI:1538379367
Name:DIANNE B GASBARRA MD PLLC
Entity type:Organization
Organization Name:DIANNE B GASBARRA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GASBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-749-0210
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-749-0210
Mailing Address - Fax:405-749-8311
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 405
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-749-0210
Practice Address - Fax:405-749-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13952207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100020190AMedicaid
OK100020190AMedicaid
OKP53633Medicare UPIN
OKC94955Medicare UPIN
OK800522373Medicare ID - Type Unspecified