Provider Demographics
NPI:1366489270
Name:TOZER, KENNETH H II (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:TOZER
Suffix:II
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 1:4022 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3453
Mailing Address - Country:US
Mailing Address - Phone:731-686-7004
Mailing Address - Fax:731-686-7078
Practice Address - Street 1:4022 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3453
Practice Address - Country:US
Practice Address - Phone:731-686-7004
Practice Address - Fax:731-686-7078
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0046019OtherBCBS
TN4231723OtherBCBS
TN016387Medicaid
TN1514532Medicaid
TN3013966Medicare ID - Type Unspecified
TN30139641Medicare PIN
TN1514532Medicaid
TN016387Medicaid