Healthcare Provider Details

I. General information

NPI: 1306042957
Provider Name (Legal Business Name): TROY STEVEN KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE SUITE #101
LITTLE ROCK AR
72205-5302
US

IV. Provider business mailing address

1308 E 900 S STE C
ST GEORGE UT
84790-8730
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-3914
  • Fax: 501-664-5246
Mailing address:
  • Phone: 356-732-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6592058-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: