Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | L0349 | TX |
NPI | 1447208756 |
---|---|
Provider Name | Dr. Erik C Koon |
First Address | Dallas, TX 75391-1230 |
Second Address | Dallas, TX 75246-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 01/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
183255201 | (05) | TX |
183255202 | (05) | TX |
200215630A | (05) | OK |
47078557540 | (05) | NE |
8W0434 | BLUE CROSS BLUE SHIELD (01) | TX |
I35765 | (02) | NE |