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General NPI Number Information
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NPI Number | 1417119603
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Entity Type | Individual
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Provider Name | REBEKAH W KOCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2008
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 1105 W FRANK AVE STE 280
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City | LUFKIN
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State | TX
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Zip | 75904-3303
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Country | US
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Telephone | 936-639-4393
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Fax | 936-639-0877
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Provider Business Mailing Address
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Address Line | 1105 W FRANK AVE STE 280
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City | LUFKIN
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State | TX
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Zip | 75904-3303
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Country | US
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Telephone | 936-639-4393
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Fax | 936-639-0877
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | BP10031404
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License Number State | TX
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