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General NPI Number Information
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NPI Number | 1023078136
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Entity Type | Individual
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Provider Name | SUSAN KOEHLER MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 IBIS DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-7398
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0068255
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License Number State | FL
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