Healthcare Provider Details

I. General information

NPI: 1942260682
Provider Name (Legal Business Name): SANDRA KOCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SANDRA KOCH MCFARREN

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MOUNTAIN ST
CARSON CITY NV
89703-3821
US

IV. Provider business mailing address

1776 BRUSH DR
CARSON CITY NV
89703-7464
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-3636
  • Fax: 775-882-2382
Mailing address:
  • Phone: 775-885-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6019
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: