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General NPI Number Information
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NPI Number | 1932196839
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Entity Type | Individual
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Provider Name | GREGORY B VANZANT D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 4200 W MEMORIAL RD STE 410
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8305
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Country | US
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Telephone | 405-608-4767
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Fax | 405-607-2976
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Provider Business Mailing Address
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Address Line | 7800 NW 85TH TER STE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-3385
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Country | US
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Telephone |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 3703
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License Number State | OK
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