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General NPI Number Information
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NPI Number | 1912908914
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Entity Type | Individual
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Provider Name | WILLIAM J KOZAK JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 2620 MEMORIAL BLVD
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-1488
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Country | US
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Telephone | 724-626-0700
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Fax | 724-626-8700
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Provider Business Mailing Address
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Address Line | 506 ATHENA DR
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City | DELMONT
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State | PA
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Zip | 15626-1005
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Country | US
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Telephone | 724-468-6869
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Fax | 724-468-6207
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD422207
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License Number State | PA
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