Individual
JEREMY CLIFTON CUZZOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
98 STATE ST, PROCTORVILLE, OH 45669-8163
(855) 446-5937
(740) 886-9374
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 886-9370
(740) 886-9374
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
35.125222
OH
207Y00000X
Otolaryngology Physician
46380
TN
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
22299
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1519145
—
TN
05
—
2667234
—
OH
05
—
3810005553
—
WV
05
—
64127202
—
KY
01
—
P00324289
RAILROAD MEDICARE
—
Enumeration date
07/05/2006
Last updated
01/21/2021
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