Healthcare Provider Details

I. General information

NPI: 1467544510
Provider Name (Legal Business Name): HENRY J KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE B321
MOBILE AL
36608-6703
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE B321
MOBILE AL
36608-6703
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0793
  • Fax: 251-633-0736
Mailing address:
  • Phone: 251-633-0793
  • Fax: 251-633-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00006665
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: