Healthcare Provider Details

I. General information

NPI: 1699177816
Provider Name (Legal Business Name): DANIEL JAMES KOCH AA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

228 MARGARET DR
COPLAY PA
18037-1719
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-7100
  • Fax:
Mailing address:
  • Phone: 484-225-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: