Organization
GLENN KOESTER, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN KOESTER M.D. (M.D.)
(405) 216-5444
Entity
Organization
Contact information
Practice address
3863 S BOULEVARD ST STE 200, EDMOND, OK 73013-5540
(405) 216-5444
Mailing address
3863 S BOULEVARD ST STE 200, EDMOND, OK 73013-5540
(405) 216-5444
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
18783
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
456922202001
BCBS IND
OK
Enumeration date
03/16/2007
Last updated
08/22/2020
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