Provider Demographics
NPI:1164443784
Name:KOZAK, SCOTT F (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:F
Last Name:KOZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2407
Mailing Address - Country:US
Mailing Address - Phone:805-898-9360
Mailing Address - Fax:805-898-9362
Practice Address - Street 1:28 W MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2407
Practice Address - Country:US
Practice Address - Phone:805-898-9360
Practice Address - Fax:805-898-9362
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62067Medicare PIN