Healthcare Provider Details

I. General information

NPI: 1740468164
Provider Name (Legal Business Name): ZOE ELIZABETH OZMENT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 8TH AVE ATTEN: EMERGENCY ROOM
FORT WORTH TX
76104-3902
US

IV. Provider business mailing address

12221 MERIT DR SUITE 1500
DALLAS TX
75251-2202
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-5292
  • Fax:
Mailing address:
  • Phone: 214-217-1911
  • Fax: 214-217-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: