MEDICARE: ZANE FREDERICK MARTIN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	200552	OK

General Provider Information

NPI Number	:	1679161608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZANE FREDERICK MARTIN CRNA

Provider Business Mailing Address
First Line	:	6839 S CANTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3402
Country	:	US
Telephone Number	:	918-494-0612
Fax Number	:	918-481-5170

Provider Business Practice Location Address
First Line	:	1120 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4012
Country	:	US
Telephone Number	:	918-579-1000
Fax Number	:

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

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	04/15/2026

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