Individual
DR. JOHN RUSSELL BOZALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 NE 13TH ST, OKLAHOMA CITY, OK 73104-5051
(405) 235-0040
(405) 235-4495
Mailing address
750 NE 13TH STREET, OKLAHOMA CITY, OK 73104-5051
(405) 235-0040
(405) 235-4495
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
8498
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100133760A
—
OK
Enumeration date
07/05/2005
Last updated
05/22/2009
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