Provider Demographics
NPI:1497947287
Name:OZAR, BETTY (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:OZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:SONNENWIRTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:130 S BEMISTON AVE STE 707
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1919
Mailing Address - Country:US
Mailing Address - Phone:314-727-8400
Mailing Address - Fax:314-726-9508
Practice Address - Street 1:130 S BEMISTON AVE STE 707
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1919
Practice Address - Country:US
Practice Address - Phone:314-727-8400
Practice Address - Fax:314-726-9508
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4F812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UPIN B18412OtherCOMMERCIAL INSURANCES
MO000002896Medicare PIN