Healthcare Provider Details

I. General information

NPI: 1811913544
Provider Name (Legal Business Name): KURT W KANTZLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S 5TH ST
GADSDEN AL
35901-4217
US

IV. Provider business mailing address

215 S 5TH ST
GADSDEN AL
35901-4217
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-2867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberDO637
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: