Provider Demographics
NPI:1801933288
Name:KOZLOFF, MATTHEW S (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:KOZLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2067 WINERIDGE PLACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-1952
Mailing Address - Country:US
Mailing Address - Phone:760-489-5955
Mailing Address - Fax:760-489-7150
Practice Address - Street 1:838 NORDAHL ROAD
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3596
Practice Address - Country:US
Practice Address - Phone:760-489-5955
Practice Address - Fax:760-489-7150
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC55616208600000X
FLME108087208600000X
KY40482208600000X, 2086S0102X, 2086S0127X
RIMD125652086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200869360Medicaid
KY7100005600Medicaid
KY50016289OtherPASSPORT
KY50016289OtherPASSPORT
KY0687848Medicare PIN