Provider Demographics
NPI:1063401255
Name:KOZLOVSKY, JOHN F (MD,PA)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:KOZLOVSKY
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 MOSSROCK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5141
Mailing Address - Country:US
Mailing Address - Phone:210-377-0350
Mailing Address - Fax:210-377-2982
Practice Address - Street 1:2929 MOSSROCK
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5141
Practice Address - Country:US
Practice Address - Phone:210-377-0350
Practice Address - Fax:210-377-2982
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0050207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110654401Medicaid
TX180040180Medicaid
00K70ZMedicare UPIN
TXF64062Medicare UPIN