Healthcare Provider Details

I. General information

NPI: 1285204933
Provider Name (Legal Business Name): PHILIP DZAMBO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HEALTHPLEX PKWY
NORMAN OK
73072-9749
US

IV. Provider business mailing address

3300 HEALTHPLEX PKWY
NORMAN OK
73072-9749
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1000
  • Fax:
Mailing address:
  • Phone: 405-307-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0460R
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number7767
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: