Provider Demographics
NPI:1538286208
Name:SASSER, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 NEW PRUE RD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-6850
Mailing Address - Country:US
Mailing Address - Phone:209-324-8725
Mailing Address - Fax:
Practice Address - Street 1:4817 NEW PRUE RD
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6850
Practice Address - Country:US
Practice Address - Phone:209-324-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53609207P00000X
TXQ7784207P00000X
OK40538207P00000X
SC1200717207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C527410Medicaid
SCTL35304OtherSTATE LICENSE
FL2656515 00Medicaid
CA00C527411Medicare PIN
FL2656515 00Medicaid
CA00C527410Medicare PIN