Provider Demographics
NPI:1952303208
Name:FERZOCO, STEVEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:FERZOCO
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:PO BOX 678063
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8063
Mailing Address - Country:US
Mailing Address - Phone:662-620-7102
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:1111 S RALEIGH AVE
Practice Address - Street 2:STE 100A
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-6350
Practice Address - Country:US
Practice Address - Phone:662-620-7102
Practice Address - Fax:662-620-7106
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023957174400000X
ALMD.239572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912081Medicaid
AL51524639OtherBC OBGYN
AL51531407OtherBC HALEYVILLE
AL51531408OtherBC RUSSELLVILLE
AL009934437Medicaid
AL009986500Medicaid
AL009912017Medicaid
AL009934438Medicaid
ALC300OtherMC GROUP
AL009978905Medicaid
AL528202620Medicaid
AL51507878OtherBC ECM
AL51543277OtherBC EAST
AL51543312OtherBC SHOALS
AL000055298OtherMEDICARE PROVIDER NUMBER
AL51524639OtherBC OBGYN
AL51531407OtherBC HALEYVILLE