Healthcare Provider Details

I. General information

NPI: 1053305003
Provider Name (Legal Business Name): LINDA S OZAKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W RIVER DR
DAVENPORT IA
52801-1014
US

IV. Provider business mailing address

500 W RIVER DR
DAVENPORT IA
52801-1014
US

V. Phone/Fax

Practice location:
  • Phone: 563-336-3000
  • Fax: 563-336-3125
Mailing address:
  • Phone: 563-336-3000
  • Fax: 563-336-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23256
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-065503
License Number StateIL

VII. Legacy identifiers

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

# 1
Identifier421060724
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBILLING TAX ID# FOR CHC
# 2
Identifier065338
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTH ALLIANCE #
# 3
Identifier8122859
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerILLINOIS BC/BS
# 4
IdentifierIA0103
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerJOHN DEERE EDI#
# 5
Identifier1221635
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerCONTROLLED SUBSTANCE#
# 6
Identifier0080200
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 7
Identifier201152
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerIOWA BC/BS
# 8
Identifier421060724002
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 9
Identifier42106072403
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerJOHN DEERE HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: