Basic Information
| Provider Information | |||||||||
| NPI: | 1013975788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OZMENT | ||||||||
| FirstName: | ELMO | ||||||||
| MiddleName: | DODD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2867 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366522867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908894 | ||||||||
| FaxNumber: | 2515442188 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 W COY SMITH HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365603201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518299884 | ||||||||
| FaxNumber: | 2518299507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 3604 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1710060 | 01 | AL | UNITED HEALTHCARE | OTHER | 011846 | 01 | AL | MEDICARE GROUP PAYEE NUMBER | OTHER | 020032330 | 01 | AL | RAILROAD MEDICARE | OTHER | 1063439065 | 01 | AL | NPI GROUP PAYEE NUMBER | OTHER | 630000013 | 05 | AL | MEDICAID |