Provider Demographics
NPI:1205017480
Name:R. KENT OZON MD PLLC
Entity Type:Organization
Organization Name:R. KENT OZON MD PLLC
Other - Org Name:PASCAGOULA NEUROLOGY PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CODING / BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:D
Authorized Official - Last Name:GEDEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-497-2652
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-0542
Mailing Address - Country:US
Mailing Address - Phone:228-522-6482
Mailing Address - Fax:228-522-6320
Practice Address - Street 1:3109 SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-1811
Practice Address - Country:US
Practice Address - Phone:228-522-6482
Practice Address - Fax:228-522-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS179092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1861483075OtherIND NPI
MS06238271Medicaid
MS130000255Medicare PIN
MSH199124Medicare UPIN