Provider Demographics
NPI:1235197815
Name:KAZMIER, W JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:JAN
Last Name:KAZMIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 FORT HENRY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4005
Mailing Address - Country:US
Mailing Address - Phone:423-246-6445
Mailing Address - Fax:423-246-8240
Practice Address - Street 1:2995 FORT HENRY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4005
Practice Address - Country:US
Practice Address - Phone:423-246-6445
Practice Address - Fax:423-246-8240
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0078009OtherBLUE CROSS/BLUE SHIELD
TN3038457Medicaid
VA079672OtherANTHEM BCBS
TN110024502OtherMEDICARE RAILROAD
TN01-41828OtherUNITED HEALTHCARE
TNTN0101OtherJOHN DEERE HEALTH
621482794OtherTAX ID
VA006036791Medicaid
TN100010179OtherPHP TENNESSEE
VA079672OtherANTHEM BCBS
TN01-41828OtherUNITED HEALTHCARE