Provider Demographics
NPI:1710064209
Name:MCMAHAN, MICHAEL ZANN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ZANN
Last Name:MCMAHAN
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 31412
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0024
Mailing Address - Country:US
Mailing Address - Phone:405-916-4545
Mailing Address - Fax:
Practice Address - Street 1:7006 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9006
Practice Address - Country:US
Practice Address - Phone:405-916-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24591332900000X
OK24591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200099900CMedicaid
OKI68327Medicare UPIN