Provider Demographics
NPI:1558384545
Name:ZDOBYLAK, EDWARD D (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:ZDOBYLAK
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:PO BOX 2339
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2339
Mailing Address - Country:US
Mailing Address - Phone:805-225-2513
Mailing Address - Fax:580-303-5863
Practice Address - Street 1:1901 W 3RD
Practice Address - Street 2:SUITEA
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-7364
Practice Address - Country:US
Practice Address - Phone:580-225-2513
Practice Address - Fax:580-303-5863
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051068A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000939921OtherANTHEM LEGACY #
IN200377800Medicaid
INH60596Medicare UPIN
IN000000939921OtherANTHEM LEGACY #