Provider Demographics
NPI:1942261318
Name:KAZOS, ALEX G (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:G
Last Name:KAZOS
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 1:2720 STONE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:712-279-3789
Mailing Address - Fax:712-279-3613
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-3789
Practice Address - Fax:712-279-3613
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28495207P00000X, 207R00000X
NE18304207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE240446OtherCOVENTRY
NE3228OtherMIDLANDS CHOICE
NEP00191999OtherRR
NE7465OtherBCBS NE
NEP00191999OtherRR
IA55510Medicare PIN
NE7465OtherBCBS NE