Provider Demographics
NPI:1972684306
Name:OZEROV, INNA (MD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:OZEROV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 DAVIE ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2516
Mailing Address - Country:US
Mailing Address - Phone:954-251-1802
Mailing Address - Fax:954-626-8145
Practice Address - Street 1:7700 DAVIE ROAD EXT
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2516
Practice Address - Country:US
Practice Address - Phone:954-251-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239439207W00000X
FL106275207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06548HMedicare PIN