Provider Demographics
NPI:1184179988
Name:ZEIDERS ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:ZEIDERS ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-753-1100
Mailing Address - Street 1:PO BOX 2342
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-2342
Mailing Address - Country:US
Mailing Address - Phone:405-753-1100
Mailing Address - Fax:405-753-5370
Practice Address - Street 1:3414 NW 135TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4009
Practice Address - Country:US
Practice Address - Phone:405-753-1100
Practice Address - Fax:405-753-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4343207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200663690AMedicaid