Provider Demographics
NPI:1114915956
Name:COZART, RALPH F (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:F
Last Name:COZART
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 1:917 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4116
Mailing Address - Country:US
Mailing Address - Phone:843-449-0453
Mailing Address - Fax:843-449-9531
Practice Address - Street 1:1021 CIPRIANA DR
Practice Address - Street 2:STE 230
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4621
Practice Address - Country:US
Practice Address - Phone:843-829-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19982208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC199822Medicaid
SCG653527908Medicare PIN
SCG65352Medicare UPIN