Provider Demographics
NPI:1821171646
Name:KOESTER, KRISTEN BREWER (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BREWER
Last Name:KOESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MICHELLE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7418 JOHN SMITH
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6020
Mailing Address - Country:US
Mailing Address - Phone:210-614-0959
Mailing Address - Fax:210-614-7522
Practice Address - Street 1:200 W OLLIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2628
Practice Address - Country:US
Practice Address - Phone:325-247-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL 2620252085R0202X
TXN01782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197245701Medicaid
TXP00628198OtherMEDICARE RAILROAD
TX8M2156OtherBCBS
TX197245701Medicaid