Provider Demographics
NPI:1912951401
Name:ZOUWAYHED, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:ZOUWAYHED
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 1:13313 N MERIDIAN AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8380
Mailing Address - Country:US
Mailing Address - Phone:405-755-4290
Mailing Address - Fax:405-755-7773
Practice Address - Street 1:13313 N MERIDIAN AVE
Practice Address - Street 2:BUILDING D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8380
Practice Address - Country:US
Practice Address - Phone:405-755-4290
Practice Address - Fax:405-755-7773
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39310207R00000X
OK26145207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200225040AMedicaid
KY64097942Medicaid
KY000000362555OtherANTHEM BC/BS
KY0601438Medicare PIN
I27637Medicare UPIN
OKOKAAA2798Medicare PIN
KY0935319Medicare PIN
KY0903669Medicare PIN
KY64097942Medicaid