| Provider / Organization | NPI | Date Certified |
|---|---|---|
| OZONE GAUTAM | 1053042366 | 2022-06-19 |
Ozone Gautam is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1053042366. Registration indicates Ozone Gautam is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Ozone Gautam MD |
| Practice Office Address | 2211 NE 139TH ST VANCOUVER, WA US |
| Practice Office Telephone | 3604871168 |
| Practice Office Fax | 5034137361 |
| Mailing Address | 2211 NE 139TH ST VANCOUVER, WA 986862742 US |
| Business Telephone | 3604871168 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | MDRE.ML.6129925
WA |