Individual
DR. GREGORY DANIEL KOSTUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S 11TH AVE STE 204, POCATELLO, ID 83201-4878
(208) 232-3355
(855) 230-7350
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
(208) 232-2408
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-14706
ID
208000000X
Pediatrics Physician
N3122
TX
Other
Enumeration date
12/29/2006
Last updated
01/06/2024
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