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General NPI Number Information
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NPI Number | 1346877172
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Entity Type | Individual
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Provider Name | WESTON ZICKGRAF
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Gender | Male
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 744 W 9TH ST
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City | TULSA
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State | OK
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Zip | 74127-9907
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Country | US
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Telephone | 918-599-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 S GARNETT RD STE 112
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City | TULSA
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State | OK
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Zip | 74146-5201
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Country | US
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Telephone | 918-935-3559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3071069
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 7305
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License Number State | OK
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