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General NPI Number Information
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NPI Number | 1811907553
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Entity Type | Individual
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Provider Name | JOHN H. KOEWLER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 555 S SCHWARTZ AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-5955
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Country | US
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Telephone | 505-327-4998
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Fax |
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Provider Business Mailing Address
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Address Line | 555 S SCHWARTZ AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-5955
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Country | US
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Telephone | 505-327-4998
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 501
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License Number State | NM
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