MEDICARE: ALI S ZAZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	20964	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376522789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI S ZAZA

Provider Business Mailing Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE 303
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-936-9966
Fax Number	:	405-756-3341

Provider Business Practice Location Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE 303
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-936-9966
Fax Number	:	405-756-3341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	04/15/2009

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Directions to “ ALI S ZAZA ” Practice Location

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