Provider Demographics
NPI:1780855247
Name:COSTER, LAURA O'BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:O'BRYAN
Last Name:COSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-1449
Mailing Address - Country:US
Mailing Address - Phone:303-425-9245
Mailing Address - Fax:303-425-1378
Practice Address - Street 1:3885 UPHAM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4880
Practice Address - Country:US
Practice Address - Phone:303-425-9245
Practice Address - Fax:303-425-1378
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO57826207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC004029M65Medicare PIN