Individual
DR. SEAN D COSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 CEDAR NE, PMG CEDAR SURGERY SUITE 306, ALBUQUERQUE, NM 87106
(505) 563-1000
(505) 247-2934
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20020306
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78136318
—
NM
Enumeration date
10/04/2006
Last updated
12/11/2009
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