MEDICARE: KERRY JAE OZER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2926	AK
2	2084P0804X	Child & Adolescent Psychiatry Physician	2926	AK

General Provider Information

NPI Number	:	1851341416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY JAE OZER M.D.

Provider Business Mailing Address
First Line	:	4341 TUDOR CENTRE DR
Second Line	:	THIRD FLOOR
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5904
Country	:	US
Telephone Number	:	907-729-2500
Fax Number	:	907-729-8552

Provider Business Practice Location Address
First Line	:	4341 TUDOR CENTRE DR
Second Line	:	THIRD FLOOR
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5904
Country	:	US
Telephone Number	:	907-729-2500
Fax Number	:	907-729-8552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/20/2014

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