Provider Demographics
NPI:1336252964
Name:KAZAR, DAVID BYRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BYRON
Last Name:KAZAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 BABCOCK ROAD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3993
Mailing Address - Country:US
Mailing Address - Phone:210-393-6920
Mailing Address - Fax:
Practice Address - Street 1:5441 BABCOCK RD
Practice Address - Street 2:SUITE #300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-393-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3970103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65003290633713A001OtherCHAMPUS
FL73193OtherBLUE CROSS & BLUE SHIELD
FL204992900Medicaid
FLOTH000Medicare UPIN
FL204992900Medicaid