Provider Demographics
NPI:1063400141
Name:MACLAREN, TANYA S (DO)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:S
Last Name:MACLAREN
Suffix:
Gender:F
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:PO BOX 108810
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8810
Mailing Address - Country:US
Mailing Address - Phone:580-272-0485
Mailing Address - Fax:580-332-5750
Practice Address - Street 1:3048 SW 89TH ST
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6359
Practice Address - Country:US
Practice Address - Phone:580-272-0485
Practice Address - Fax:580-332-5750
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3587207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100189620AMedicaid
OK175779900OtherDEPT OF LABOR
OK731611350001OtherBCBS OF OK
OK7437254OtherAETNA
OK731611350001OtherBCBS OF OK
OK175779900OtherDEPT OF LABOR
050084771Medicare PIN