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NPI Code Detail

MEDICARE: PHOEBE KOCH M.D.

MEDICARE: PHOEBE KOCH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician54162MN
2207N00000XDermatology Physician49736MT

General Provider Information

NPI Number : 1194907741
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHOEBE KOCH M.D.
Provider Business Mailing Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-587-4432
Fax Number : 406-587-7015
Provider Business Practice Location Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-587-4432
Fax Number : 406-587-7015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2007
Last Update Date : 07/27/2020

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