Provider Demographics
NPI:1861483075
Name:OZON, ROBERT K (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:OZON
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 1:9344 THREE RIVERS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4268
Mailing Address - Country:US
Mailing Address - Phone:228-865-9898
Mailing Address - Fax:228-863-5616
Practice Address - Street 1:9344 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4268
Practice Address - Country:US
Practice Address - Phone:228-865-9898
Practice Address - Fax:228-863-5616
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS179092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06238271Medicaid
200850319OtherCHAMPUS & COMMERCIAL
MS06238271Medicaid
MS130000255Medicare ID - Type Unspecified