Healthcare Provider Details

I. General information

NPI: 1326136789
Provider Name (Legal Business Name): RONALD M KOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SO MAIN ST
NEW CASTLE KY
40050
US

IV. Provider business mailing address

PO BOX 189 15 SO MAIN ST
NEW CASTLE KY
40050
US

V. Phone/Fax

Practice location:
  • Phone: 502-845-7550
  • Fax: 502-845-5551
Mailing address:
  • Phone: 502-845-7550
  • Fax: 502-845-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16737
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: