Provider Demographics
NPI:1881881118
Name:STEVEN E OZERAN, M.D., P.A.
Entity type:Organization
Organization Name:STEVEN E OZERAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:JEFFREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-746-4479
Mailing Address - Street 1:1630 23RD AVE
Mailing Address - Street 2:SUITE 901A
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6350
Mailing Address - Country:US
Mailing Address - Phone:208-746-4479
Mailing Address - Fax:208-746-4186
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:SUITE 901A
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6350
Practice Address - Country:US
Practice Address - Phone:208-746-4479
Practice Address - Fax:208-746-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA10143154Medicaid
G06549Medicare UPIN
ID1132883Medicare PIN
WA10143154Medicaid