Individual
GLENN ALAN KOESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3863 S. BOULEVARD, EDMOND, OK 73034
(405) 216-5444
(405) 216-5445
Mailing address
3863 S. BOULEVARD, EDMOND, OK 73034
(405) 216-5444
(405) 216-5445
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
18783
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100152170B
—
OK
Enumeration date
08/25/2006
Last updated
07/19/2013
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