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General NPI Number Information
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NPI Number | 1336102086
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Entity Type | Organization
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Legal Business Name | DEXTER D KOONS MD PC
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 400 W 16TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2745
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Country | US
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Telephone | 719-320-3515
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Fax | 719-543-1309
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Provider Business Mailing Address
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Address Line | PO BOX 8561
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City | PUEBLO
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State | CO
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Zip | 81008-8561
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Country | US
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Telephone | 719-320-3515
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Fax | 719-543-1309
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEXTER D KOONS
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Credential | M.D.
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Telephone | 719-296-6872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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