Healthcare Provider Details

I. General information

NPI: 1851387344
Provider Name (Legal Business Name): JAMES J KOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E OSBORN RD STE 100
PHOENIX AZ
85012-2347
US

IV. Provider business mailing address

2111 E HIGHLAND AVE STE 240
PHOENIX AZ
85016-4794
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-5012
  • Fax: 480-994-9479
Mailing address:
  • Phone: 480-994-5012
  • Fax: 480-994-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number32672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: