Provider Demographics
NPI:1932196839
Name:VANZANT, GREGORY B (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:VANZANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 NW 85TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 W MEMORIAL RD STE 410
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8305
Practice Address - Country:US
Practice Address - Phone:405-608-4767
Practice Address - Fax:405-607-2976
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3703207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131230AMedicaid
OK0600063404OtherRAILROAD MEDIARE
OKF98792Medicare UPIN
OK100131230AMedicaid
OK24H616550Medicare PIN
OKOKA100827Medicare PIN