Provider Demographics
NPI:1053413237
Name:KENNETH H. TOZER II, MD
Entity type:Organization
Organization Name:KENNETH H. TOZER II, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:TOZER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:731-686-7004
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN03013966Medicaid
TN3013964Medicaid
TN0046019OtherBCBS
TN03734638Medicaid
TN3013964Medicare ID - Type Unspecified
TN3013966Medicare ID - Type Unspecified
TN03734638Medicaid
TN3734638Medicare ID - Type Unspecified