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General NPI Number Information
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NPI Number | 1295274660
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Entity Type | Organization
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Legal Business Name | KOE MEDICAL CONSULTING, INC.
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 5680 TRINIDAD WAY
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City | SAN DIEGO
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State | CA
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Zip | 92114-5310
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Country | US
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Telephone | 773-398-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 2754 IMPERIAL AVE
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City | SAN DIEGO
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State | CA
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Zip | 92102-4031
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Country | US
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Telephone | 773-398-6867
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY ELMORE
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Credential | MD
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Telephone | 773-398-6867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A105818
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License Number State | CA
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