Healthcare Provider Details

I. General information

NPI: 1770640856
Provider Name (Legal Business Name): ZEGUANG REN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 S YALE AVE STE 308
TULSA OK
74136-7802
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 340
TAMPA FL
33613-4681
US

V. Phone/Fax

Practice location:
  • Phone: 918-499-4000
  • Fax: 918-499-4001
Mailing address:
  • Phone: 813-467-4290
  • Fax: 813-467-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME118822
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberDR.0067702
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number47878
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: