Provider Demographics
NPI:1891358644
Name:DOSTER, KATHRYN M (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:DOSTER
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2145 CAJA DEL ORO GRANT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3279
Mailing Address - Country:US
Mailing Address - Phone:505-982-4425
Mailing Address - Fax:505-982-1263
Practice Address - Street 1:2145 CAJA DEL ORO GRANT RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3279
Practice Address - Country:US
Practice Address - Phone:505-982-4425
Practice Address - Fax:505-982-1263
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDO2022-0088207Q00000X
COTL0007851390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine