MEDICARE: DR. DAVID JAMES KOSTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	G64875	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PO1345510	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063406163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAMES KOSTER M.D.

Provider Business Mailing Address
First Line	:	7130 N MILLBROOK AVE
Second Line	:	SUITE 100
City	:	FRESNO
State	:	CA
Zip	:	93720-3347
Country	:	US
Telephone Number	:	559-447-4949
Fax Number	:	559-447-4925

Provider Business Practice Location Address
First Line	:	7130 N MILLBROOK AVE
Second Line	:	SUITE 100
City	:	FRESNO
State	:	CA
Zip	:	93720-3347
Country	:	US
Telephone Number	:	559-326-1238
Fax Number	:	559-326-1230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	11/05/2021

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