Individual
DAVID A KOSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11512 LAKE MEAD AVE, UNIT 534, JACKSONVILLE, FL 32256-9680
(904) 642-2222
(904) 683-3934
Mailing address
11945 SAN JOSE BLVD 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 399-1717
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME68360
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000685836A
—
GA
01
—
180022583
RAILROAD MEDICARE
FL
01
—
27478
BLUE CROSS BLUE SHIELD
FL
05
—
377942400
—
FL
Enumeration date
10/24/2005
Last updated
12/30/2015
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