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General NPI Number Information
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NPI Number | 1568723476
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Entity Type | Organization
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Legal Business Name | INNA OZEROV MD PA
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 7700 DAVIE ROAD EXT
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2516
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Country | US
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Telephone | 954-251-1802
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 DAVIE ROAD EXT
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2516
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Country | US
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Telephone | 954-251-1802
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Fax | 954-626-8145
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Authorized Official
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Title or Position | M.D.
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Name | INNA OZEROV
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Credential | M.D.
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Telephone | 954-251-1802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME106275
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License Number State | FL
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