Healthcare Provider Details

I. General information

NPI: 1548290505
Provider Name (Legal Business Name): ZACHARY DANIEL ZANOWIAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD
EDMOND OK
73013-3023
US

IV. Provider business mailing address

608 NW 9TH ST STE 6210
OKLAHOMA CITY OK
73102-1069
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-2400
  • Fax: 405-948-6507
Mailing address:
  • Phone: 405-272-9641
  • Fax: 405-235-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number40797
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22842
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: