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NPI Code Detail

MEDICARE: DR. ALBERT SAMUEL KOENIG III M.D.

MEDICARE: DR. ALBERT SAMUEL KOENIG III M.D.
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
1207Q00000XFamily Medicine PhysicianC4336AR
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianC4336AR
3207ZP0105XClinical Pathology/Laboratory Medicine PhysicianC4336AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152965OTHERARBLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number : 1801894738
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALBERT SAMUEL KOENIG III M.D.
Provider Business Mailing Address
First Line : 2420 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4164
Country : US
Telephone Number : 479-782-4000
Fax Number : 479-782-0267
Provider Business Practice Location Address
First Line : 2420 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4164
Country : US
Telephone Number : 479-782-4000
Fax Number : 479-782-0267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 07/18/2007

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