Basic Information
| Provider Information | |||||||||
| NPI: | 1598805939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZLOWSKI | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | LLOYD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 KING RICHARD BLVD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347998024 | ||||||||
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| Practice Location | |||||||||
| Address1: | CORNER OF VETERAN'S WAY AND LAMONT | ||||||||
| Address2: | J H QUILLEN VA MEDICAL CENTER | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101041114 | VA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.