Individual
DR. JOHN JOSEPH COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
81 LOOP 150 W, BASTROP, TX 78602-3930
(512) 308-9100
(512) 581-5005
Mailing address
81 LOOP 150 W, BASTROP, TX 78602-3930
(512) 308-9100
(512) 581-5005
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E4972
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T610
BCBS PROVIDER NUMBER
TX
Enumeration date
09/19/2006
Last updated
10/11/2007
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