Provider Demographics
NPI:1881878627
Name:OZO, JOHN A
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:OZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BLACK CORAL DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-5436
Mailing Address - Country:US
Mailing Address - Phone:972-216-4894
Mailing Address - Fax:972-285-5185
Practice Address - Street 1:702 BLACK CORAL DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5436
Practice Address - Country:US
Practice Address - Phone:972-216-4894
Practice Address - Fax:972-285-5185
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0011725251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1023106796Medicare Oscar/Certification