Healthcare Provider Details

I. General information

NPI: 1952303208
Provider Name (Legal Business Name): STEVEN A FERZOCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S RALEIGH AVE STE 100A
SHEFFIELD AL
35660-6350
US

IV. Provider business mailing address

PO BOX 678063
DALLAS TX
75267-8063
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-7102
  • Fax: 662-620-7106
Mailing address:
  • Phone: 662-620-7102
  • Fax: 662-620-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00023957
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.23957
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: