Provider Demographics
NPI:1366496176
Name:ZANO, MERCEDES LAZARO (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:LAZARO
Last Name:ZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:LAZARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9001S 101ST EAST AVE 230
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5797
Mailing Address - Country:US
Mailing Address - Phone:918-392-5411
Mailing Address - Fax:918-392-5416
Practice Address - Street 1:9001S 101ST EAST AVE 230
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5797
Practice Address - Country:US
Practice Address - Phone:918-392-5411
Practice Address - Fax:918-392-5416
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100021490AMedicaid
OK100021490AMedicaid
OKG20837Medicare UPIN