Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 23034 | NE |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 23034 | NE |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 23034 | NE |
NPI | 1245205947 |
---|---|
Provider Name | Dr. Douglas A Koch |
First Address | Lincoln, NE 68510-4120 |
Second Address | Lincoln, NE 68510-4120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 04/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200347450A | MEDICAID (01) | KS |
247111 | MIDLANDS CHOICE (01) | NE |
30014 | BCBS OF NEBRASKA (01) | NE |
91177983268510A017 | TRI CARE (01) | NE |
I10618 | (02) | |
P00246735 | RAILROAD MEDICARE (01) | NE |