Provider Demographics
NPI:1467782854
Name:JOHN G OSTER MD PC
Entity Type:Organization
Organization Name:JOHN G OSTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:OSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-424-5555
Mailing Address - Street 1:2472 PATTERSON ROAD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1285
Mailing Address - Country:US
Mailing Address - Phone:970-424-5555
Mailing Address - Fax:970-424-5027
Practice Address - Street 1:2472 PATTERSON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1285
Practice Address - Country:US
Practice Address - Phone:970-424-5555
Practice Address - Fax:970-424-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353630Medicaid
CO01353630Medicaid
COCOB4946Medicare PIN