Healthcare Provider Details

I. General information

NPI: 1942242003
Provider Name (Legal Business Name): DOUGLAS P KOEHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S HIGHWAY 65
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

PO BOX 104240
JEFFERSON CITY MO
65110-4240
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-3364
  • Fax: 660-886-6044
Mailing address:
  • Phone: 573-635-5264
  • Fax: 573-556-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2K32
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: