Provider Demographics
NPI:1316279326
Name:KOZAK, JEFFREY ALAN (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:KOZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S STE 525
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3519
Mailing Address - Country:US
Mailing Address - Phone:713-661-7888
Mailing Address - Fax:713-661-7899
Practice Address - Street 1:6565 WEST LOOP S STE 525
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3519
Practice Address - Country:US
Practice Address - Phone:713-661-7888
Practice Address - Fax:713-661-7899
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP0619207QA0401X, 207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine