Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD00032850 | WA |
Y | 208600000X | Surgeon | MD00032850 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | M6830 | ID |
NPI | 1316911571 |
---|---|
Provider Name | Mr. Steven Edwin Ozeran |
First Address | Lewiston, ID 83501 |
Second Address | Lewiston, ID 83501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002773500 | (05) | ID |
10143154 | REGENCE BLUE SHIELD (01) |