Provider Demographics
NPI:1013975788
Name:OZMENT, ELMO DODD JR (MD)
Entity type:Individual
Prefix:
First Name:ELMO
Middle Name:DODD
Last Name:OZMENT
Suffix:JR
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 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8894
Mailing Address - Fax:251-544-2188
Practice Address - Street 1:950 W COY SMITH HWY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560-3201
Practice Address - Country:US
Practice Address - Phone:251-829-9884
Practice Address - Fax:251-829-9507
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1710060OtherUNITED HEALTHCARE
AL011846OtherMEDICARE GROUP PAYEE NUMBER
AL020032330OtherRAILROAD MEDICARE
AL1063439065OtherNPI GROUP PAYEE NUMBER
AL630000013Medicaid
AL630000013Medicaid
AL16959Medicare ID - Type Unspecified