Provider Demographics
NPI:1053588517
Name:BAZLER, AMBER (MD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:BAZLER
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 1:5711 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6628
Mailing Address - Country:US
Mailing Address - Phone:918-203-6800
Mailing Address - Fax:918-203-6801
Practice Address - Street 1:5711 E 71ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6655
Practice Address - Country:US
Practice Address - Phone:918-203-6800
Practice Address - Fax:918-203-6801
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK29767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05212Medicaid