Provider Demographics
NPI:1306916267
Name:DROZD, JOHN FRANK (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:DROZD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21ST MEDICAL GROUP
Mailing Address - Street 2:559 VINCENT STREET
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914
Mailing Address - Country:US
Mailing Address - Phone:719-556-7804
Mailing Address - Fax:
Practice Address - Street 1:21ST MEDICAL GROUP
Practice Address - Street 2:559 VINCENT STREET
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914
Practice Address - Country:US
Practice Address - Phone:719-556-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2529103TC0700X
GA50985103TC0700X
DEB1-0000714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO331000460OtherTAX ID NUMBER