Provider Demographics
NPI:1124106786
Name:OZOG, MARK FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:FRANCIS
Last Name:OZOG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1417 9TH ST SO
Mailing Address - Street 2:#100
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4503
Mailing Address - Country:US
Mailing Address - Phone:406-453-1613
Mailing Address - Fax:406-453-3717
Practice Address - Street 1:1417 9TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4509
Practice Address - Country:US
Practice Address - Phone:406-453-1613
Practice Address - Fax:406-453-3717
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT7816207W00000X
CO29408207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT180023007OtherRAILROAD MEDICARE
MT000009731OtherBLUE CROSS BLUE SHIELD
MT0014053Medicaid