Healthcare Provider Details

I. General information

NPI: 1053413237
Provider Name (Legal Business Name): KENNETH H. TOZER II, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 LIBERTY ST
MILAN TN
38358-3453
US

IV. Provider business mailing address

4022 LIBERTY ST
MILAN TN
38358-3453
US

V. Phone/Fax

Practice location:
  • Phone: 731-686-7004
  • Fax: 731-686-7078
Mailing address:
  • Phone: 731-686-7004
  • Fax: 731-686-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD016387
License Number StateTN

VIII. Authorized Official

Name: DR. KENNETH HAROLD TOZER II
Title or Position: SURGEON
Credential: M.D.
Phone: 731-686-7004