Provider Demographics
NPI:1821076886
Name:KOSTERS, GREGORY JAY (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAY
Last Name:KOSTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 9TH AVE N
Mailing Address - Street 2:#277
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-0277
Mailing Address - Country:US
Mailing Address - Phone:712-754-3658
Mailing Address - Fax:712-754-2634
Practice Address - Street 1:600 9TH AVE N
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1012
Practice Address - Country:US
Practice Address - Phone:712-754-3658
Practice Address - Fax:712-754-2634
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115479OtherUCARE
IA1304516OtherSTATE PHARMACY NUMBER
10123OtherPREFERRED ONE
SD7771982Medicaid
52254OtherBAAI
MN9D043KOOtherMN BLUE SHIELD
IA52254OtherBLUE SHIELD
21097OtherSIOX VALLEY HEALTH PLAN
IA2228510Medicaid
MN539723500OtherMN MEDICAL ASSISTANCE
MN539723500OtherMN MEDICAL ASSISTANCE
SD7771982Medicaid
AO2725Medicare UPIN