Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036.154248 | IL |
N | 207P00000X | Emergency Physician | 278200 | MA |
N | 207PE0004X | Emergency Medical Services | 036.154248 | IL |
NPI | 1063808079 |
---|---|
Provider Name | Alexander Benjamin Zozula |
First Address | Alton, IL 62002-6722 |
Second Address | Alton, IL 62002-6722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 01/12/2021 |