MEDICARE: DR. ROY DOUGLAS OZANNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	20632-020	WI

General Provider Information

NPI Number	:	1790910990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY DOUGLAS OZANNE MD

Provider Business Mailing Address
First Line	:	12321 SANDY BAY RD
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-9550
Country	:	US
Telephone Number	:	920-755-2448
Fax Number	:

Provider Business Practice Location Address
First Line	:	12321 SANDY BAY RD
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-9550
Country	:	US
Telephone Number	:	920-755-2448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	06/21/2026

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