Healthcare Provider Details

I. General information

NPI: 1215972138
Provider Name (Legal Business Name): MARK D KOZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY 1002
RENO NV
89502-1475
US

IV. Provider business mailing address

75 PRINGLE WAY 1002
RENO NV
89502-1475
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-7500
  • Fax: 775-789-9208
Mailing address:
  • Phone: 775-323-7500
  • Fax: 775-789-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4575
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: