Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | P0619 | TX |
N | 207QA0401X | Family Doctor - Addiction Medicine | P0619 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | P0619 | TX |
NPI | 1316279326 |
---|---|
Provider Name | Jeffrey Alan Kozak |
First Address | Bellaire, TX 77401-3519 |
Second Address | Bellaire, TX 77401-3519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 03/01/2020 |