Provider Demographics
NPI:1235395591
Name:ZENGOU, RYAN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALEXANDER
Last Name:ZENGOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8210
Practice Address - Street 1:6475 S YALE AVE STE 308
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7802
Practice Address - Country:US
Practice Address - Phone:918-499-4000
Practice Address - Fax:918-499-4001
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42346207T00000X
IL036142030207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1235395591Medicaid