Provider Demographics
NPI:1851341416
Name:OZER, KERRY JAE (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:JAE
Last Name:OZER
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 1:4341 TUDOR CENTRE DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-2500
Mailing Address - Fax:907-729-8552
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-2500
Practice Address - Fax:907-729-8552
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK29262084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD29261Medicaid
AK8EL703Medicare PIN
AK8EL706Medicare PIN
AK8EL707Medicare PIN
AK8EL704Medicare PIN
AK8EI356Medicare PIN
AK8EL705Medicare PIN
AK8EI357Medicare PIN
AKMD29262Medicaid
AK8EF447Medicare PIN