Provider Demographics
NPI:1013960921
Name:BOZIC, KEVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:BOZIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 BARBARA JORDAN BLVD
Mailing Address - Street 2:DEPT OF SURGERY AND PERIOPERATIVE CARE - STE. 1.114 AC
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3092
Mailing Address - Country:US
Mailing Address - Phone:512-495-5089
Mailing Address - Fax:512-324-8906
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1000
Practice Address - Country:US
Practice Address - Phone:512-454-4561
Practice Address - Fax:512-406-7330
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81571207X00000X
TXQ3646207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A815710Medicaid
TX351396201Medicaid
TX351396201Medicaid
TX442125YKXVMedicare PIN
CA00A815710Medicare PIN