Healthcare Provider Details

I. General information

NPI: 1245268549
Provider Name (Legal Business Name): RAYMOND A KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 HARRIS ST
EUREKA CA
95503-4809
US

IV. Provider business mailing address

2826 HARRIS ST
EUREKA CA
95503-4809
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-8033
  • Fax: 707-268-3250
Mailing address:
  • Phone: 707-443-8033
  • Fax: 707-268-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG29777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: