Individual
DR. HOLLY BRIANN COSTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4200 S DOUGLAS AVE, STE 306, OKLAHOMA CITY, OK 73109-3223
(405) 636-7195
Mailing address
4200 S DOUGLAS AVE, STE 306, OKLAHOMA CITY, OK 73109-3223
(405) 636-7195
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4709
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226070A
—
OK
01
—
4709
MEDICAL LICENSE
OK
Enumeration date
10/16/2008
Last updated
02/08/2011
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