Individual
DR. RICHARD LANDE KOZOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
6362 MAIN STREET, CUBA, NM 87013
(505) 289-3326
(505) 289-3390
Mailing address
PO BOX 638, CUBA, NM 87013-0638
(505) 289-3291
(505) 289-0025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
72-173
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26013
—
NM
Enumeration date
06/09/2006
Last updated
05/29/2008
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