Provider Demographics
NPI:1063595437
Name:KOZAK, BRYAN CHRISTOPHER (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:KOZAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10207 CERNY ST STE 312
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4887
Mailing Address - Country:US
Mailing Address - Phone:919-660-8346
Mailing Address - Fax:
Practice Address - Street 1:10207 CERNY ST STE 312
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-4887
Practice Address - Country:US
Practice Address - Phone:919-660-8346
Practice Address - Fax:919-668-2563
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1073875363A00000X
NC0010-06354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant