1477807378 NPI number — STEPHEN OZANNE M.D., P.A.

Table of content: (NPI 1477807378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477807378 NPI number — STEPHEN OZANNE M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN OZANNE M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477807378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 543066
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75054-3066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-299-6966
Provider Business Mailing Address Fax Number:
972-299-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 W WHEATLAND RD
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-3470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-299-6966
Provider Business Practice Location Address Fax Number:
972-299-9100
Provider Enumeration Date:
10/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OZANNE
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-299-6966

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  G8637 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0026EN . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 225336 . This is a "BLUE LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4201257 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122086504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 844754 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".




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