Healthcare Provider Details

I. General information

NPI: 1013960921
Provider Name (Legal Business Name): KEVIN J. BOZIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 102
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

1400 BARBARA JORDAN BLVD DEPT OF SURGERY AND PERIOPERATIVE CARE - STE. 1.114 AC
AUSTIN TX
78723-3092
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4561
  • Fax: 512-406-7330
Mailing address:
  • Phone: 512-495-5089
  • Fax: 512-324-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA81571
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberQ3646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: