Provider Demographics
NPI:1780323907
Name:KOSKI, TEGAN (MD)
Entity type:Individual
Prefix:
First Name:TEGAN
Middle Name:
Last Name:KOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEGAN
Other - Middle Name:
Other - Last Name:NOONAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5502 MARVIN SHIELDS BLVD
Mailing Address - Street 2:BLDG 472
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-822-5409
Mailing Address - Fax:
Practice Address - Street 1:5502 MARVIN SHIELDS BLVD
Practice Address - Street 2:BLDG 472
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-822-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD91062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine