Healthcare Provider Details

I. General information

NPI: 1881007433
Provider Name (Legal Business Name): COEN LAURENS KLOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 6TH AVE W STE 100
HENDERSONVILLE NC
28739-4160
US

IV. Provider business mailing address

805 6TH AVE W STE 100
HENDERSONVILLE NC
28739-4160
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-7230
  • Fax: 828-698-0583
Mailing address:
  • Phone: 828-693-7230
  • Fax: 828-698-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberBB4745785-2014014713
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number2023-03132
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: