Provider Demographics
NPI:1770562464
Name:KOSTUR, ALEXANDRA M (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:M
Last Name:KOSTUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 BAYMEADOWS RD E STE 207
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9666
Mailing Address - Country:US
Mailing Address - Phone:904-446-9991
Mailing Address - Fax:904-446-9992
Practice Address - Street 1:7807 BAYMEADOWS RD E STE 207
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9666
Practice Address - Country:US
Practice Address - Phone:904-446-9991
Practice Address - Fax:904-446-9992
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082408208000000X
FLME100724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2412964Medicaid