Provider Demographics
NPI:1477807378
Name:STEPHEN OZANNE M.D., P.A.
Entity type:Organization
Organization Name:STEPHEN OZANNE M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OZANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-299-6966
Mailing Address - Street 1:PO BOX 543066
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-3066
Mailing Address - Country:US
Mailing Address - Phone:972-299-6966
Mailing Address - Fax:972-299-9100
Practice Address - Street 1:3450 W WHEATLAND RD
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3470
Practice Address - Country:US
Practice Address - Phone:972-299-6966
Practice Address - Fax:972-299-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8637207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0026ENOtherBCBS
225336OtherBLUE LINK
4201257OtherAETNA
TX122086504Medicaid
844754OtherHMO BLUE
4201257OtherAETNA
225336OtherBLUE LINK