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General NPI Number Information
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NPI Number | 1265774533
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Entity Type | Individual
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Provider Name | ANDRA KOFAHL M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 2301 W WHITE AVE 611
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City | MCKINNEY
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State | TX
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Zip | 75071-3119
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Country | US
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Telephone | 262-989-7856
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Fax |
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Provider Business Mailing Address
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Address Line | 301 JENNY GEORGE LANE BUILDING A, SUITE E
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City | SWEETWATER
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State | TX
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Zip | 79556
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Country | US
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Telephone | 325-235-1942
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PROVISIONAL
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License Number State | TX
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