Provider Demographics
NPI:1023116530
Name:KOSTER, ROBERT LOUIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
Last Name:KOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-823-4200
Mailing Address - Fax:214-823-2591
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-823-4200
Practice Address - Fax:214-823-2591
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125488006Medicaid
845113OtherBCBS
TX125488004Medicaid
110040883OtherRR MEDICARE
4046808OtherAETNA
110040883OtherRR MEDICARE
TX125488004Medicaid
4046808OtherAETNA
TXTXB130899Medicare PIN