MEDICARE: JONATHAN KOEHLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	DO2024-0152	NM

General Provider Information

NPI Number	:	1073199873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KOEHLER

Provider Business Mailing Address
First Line	:	PO BOX 6103
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87197-6103
Country	:	US
Telephone Number	:
Fax Number	:	505-217-3950

Provider Business Practice Location Address
First Line	:	1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-5705
Country	:	US
Telephone Number	:	505-272-2231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	07/01/2025

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Directions to “ JONATHAN KOEHLER ” Practice Location

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