Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1162606 | TX |
Y | 213ES0000X | Sports Medicine | 1162606 | TX |
NPI | 1083892996 |
---|---|
Provider Name | Mrs. Brandi Marie Kozemski |
First Address | Longview, TX 75601 |
Second Address | Longview, TX 75601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2008 |
Last Update Date | 01/02/2008 |