Healthcare Provider Details

I. General information

NPI: 1336252964
Provider Name (Legal Business Name): DAVID BYRON KAZAR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 BABCOCK RD SUITE #300
SAN ANTONIO TX
78240-3993
US

IV. Provider business mailing address

5441 BABCOCK ROAD SUITE #300
SAN ANTONIO TX
78023-3993
US

V. Phone/Fax

Practice location:
  • Phone: 210-393-6920
  • Fax:
Mailing address:
  • Phone: 210-393-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3970
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3970
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY3970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: