Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 04-33833 | KS |
N | 2080A0000X | Adolescent Medicine | 04-33833 | KS |
NPI | 1003089160 |
---|---|
Provider Name | Dr. Christopher Joseph Koster |
First Address | Great Bend, KS 67530-3213 |
Second Address | Great Bend, KS 67530-3213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 07/03/2012 |