Healthcare Provider Details

I. General information

NPI: 1518915305
Provider Name (Legal Business Name): DAVID J LOZANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 MONTGOMERY HWY
DOTHAN AL
36303-1552
US

IV. Provider business mailing address

126 CLINIC DR
DOTHAN AL
36303-1980
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1881
  • Fax: 334-340-5918
Mailing address:
  • Phone: 334-793-1881
  • Fax: 334-340-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.24011
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD.24011
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009961870
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier1518915305
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerTRICARE SOUTH
# 3
Identifier7690295
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerAETNA
# 4
Identifier515-33484
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS
# 5
Identifier515-48612
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS
# 6
Identifier023023000
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: