Healthcare Provider Details

I. General information

NPI: 1346299724
Provider Name (Legal Business Name): JARED J KOCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E OAK ST
FORT BRANCH IN
47648-1666
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-753-3942
  • Fax: 812-768-6283
Mailing address:
  • Phone: 812-753-3942
  • Fax: 812-768-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01071228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: