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General NPI Number Information
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NPI Number | 1689700494
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Entity Type | Individual
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Provider Name | KIM EDWARD KOGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 210 JUPITER LAKES BLVD BLDG 5000 SUITE 202
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City | JUPITER
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State | FL
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Zip | 33458-7191
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Country | US
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Telephone | 561-748-1565
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Fax | 561-748-1568
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Provider Business Mailing Address
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Address Line | 4600 MILITARY TRAIL SUITE 202
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-748-1565
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Fax | 561-748-1568
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 75895
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME75895
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License Number State | FL
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