Healthcare Provider Details

I. General information

NPI: 1114915956
Provider Name (Legal Business Name): RALPH F COZART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 HIGHWAY 17 STE C
MURRELLS INLET SC
29576-5014
US

IV. Provider business mailing address

3911 HIGHWAY 17 STE C
MURRELLS INLET SC
29576-5014
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-7771
  • Fax: 843-652-4005
Mailing address:
  • Phone: 843-497-7771
  • Fax: 843-652-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number19982
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: