Provider Demographics
NPI:1316911571
Name:OZERAN, STEVEN EDWIN (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EDWIN
Last Name:OZERAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 23RD AVE
Mailing Address - Street 2:STE 901A
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-746-4479
Mailing Address - Fax:208-746-4186
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:STE 901A
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-746-4479
Practice Address - Fax:208-746-4186
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032850208200000X
IDM68302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002773500Medicaid
10143154OtherREGENCE BLUE SHIELD
WAAB01507Medicare ID - Type Unspecified
ID002773500Medicaid
G06549Medicare UPIN