Provider Demographics
NPI:1811087315
Name:ZANOVICH, TERRY L (MD)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:ZANOVICH
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 1:2000 S. WHEELING AVE.
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-747-9641
Mailing Address - Fax:918-749-7806
Practice Address - Street 1:2000 S. WHEELING AVE.
Practice Address - Street 2:SUITE 800
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-747-9641
Practice Address - Fax:918-749-7806
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3210529OtherCIGNA
OK73-0792126-005OtherBCBS
OK0545040OtherAETNA
OK3210529OtherCIGNA