Healthcare Provider Details

I. General information

NPI: 1669148847
Provider Name (Legal Business Name): ZANE PEDERSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 13TH ST
OKLAHOMA CITY OK
73104-5040
US

IV. Provider business mailing address

1417 N KLEIN AVE
OKLAHOMA CITY OK
73106-4413
US

V. Phone/Fax

Practice location:
  • Phone: 572-244-0063
  • Fax:
Mailing address:
  • Phone: 405-312-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45823
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: