Provider Demographics
NPI:1629465802
Name:ABU ANZA, OMAR A (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:A
Last Name:ABU ANZA
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 1:1200 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:452-271-4411
Mailing Address - Fax:
Practice Address - Street 1:1200 EVERETT DR # NP2350
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-271-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK384272080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology