Individual
PETER S KOSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3377 RIVERBEND DR, SPRINGFIELD, OR 97477
(541) 222-8400
(541) 222-8401
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1253
(360) 729-3185
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
MD18619
OR
208VP0014X
Interventional Pain Medicine Physician
18619
OR
208VP0014X
Interventional Pain Medicine Physician
Primary
MD18619
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006439001
REGENCE BCBSO
OR
05
—
062781
—
OR
Enumeration date
05/13/2006
Last updated
06/29/2021
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