Healthcare Provider Details

I. General information

NPI: 1477548980
Provider Name (Legal Business Name): DR. GEORGE KOZMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 STICKNEY POINT RD
SARASOTA FL
34231-6019
US

IV. Provider business mailing address

PO BOX 915193
ORLANDO FL
32891-5193
US

V. Phone/Fax

Practice location:
  • Phone: 941-342-8200
  • Fax: 941-342-8201
Mailing address:
  • Phone: 941-342-8200
  • Fax: 941-342-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME25764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: