Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A168921 | CA |
N | 208800000X | Urologist | DR.0060248 | CO |
NPI | 1043655525 |
---|---|
Provider Name | David Stewart Koslov |
First Address | San Bernardino, CA 92404-4816 |
Second Address | San Bernardino, CA 92404-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 02/09/2020 |