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General NPI Number Information
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NPI Number | 1306841044
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Entity Type | Individual
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Provider Name | DAVID G KOO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2005
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 1000 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778
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Country | US
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Telephone | 352-742-8836
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Fax | 352-742-8829
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Provider Business Mailing Address
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Address Line | 1737 DAVID WALKER DR
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City | TAVARES
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State | FL
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Zip | 32778-5745
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Country | US
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Telephone | 352-742-8836
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Fax | 352-742-8829
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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 | ME108164
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35075829
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME108164
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License Number State | FL
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