Provider Demographics
NPI:1316130040
Name:KOZA, JOSEPH MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:KOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:RT 1022
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3831
Practice Address - Country:US
Practice Address - Phone:972-863-6100
Practice Address - Fax:281-209-8930
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFTL41872207P00000X
TXN0903207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187289704Medicaid
TX1316130040OtherTRICARE
TX8BZ141OtherBLUE CROSS BLUE SHIELD OF TEXAS
TXP00697292OtherRAILROAD MEDICARE
TX187289704Medicaid
TX8L12141Medicare PIN