Healthcare Provider Details

I. General information

NPI: 1710943790
Provider Name (Legal Business Name): ERIC JON KOZLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DAVIS ST
ASHEBORO NC
27203
US

IV. Provider business mailing address

100 WESTWOOD AVENUE
HIGH POINT NC
27262-4320
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-5770
  • Fax: 336-629-0130
Mailing address:
  • Phone: 336-883-1393
  • Fax: 336-883-7517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9500975
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number9500975
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: