Provider Demographics
NPI:1447578752
Name:KOSKO, MARK GILL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GILL
Last Name:KOSKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:STE 330
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2027
Mailing Address - Country:US
Mailing Address - Phone:601-353-2020
Mailing Address - Fax:601-714-5110
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:STE 330
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-353-2020
Practice Address - Fax:601-352-5988
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS23717207W00000X
ALMD.33192207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05508385Medicaid
MS05508385Medicaid
MS407487YJ5DMedicare PIN