Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | M9423 | TX |
NPI | 1982878195 |
---|---|
Provider Name | Dr. William Karl Koeck |
First Address | San Antonio, TX 78258-4210 |
Second Address | San Antonio, TX 78258-4210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 19/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
199743901 | (05) | TX |
199743902 | (05) | TX |
199743903 | (05) | TX |
199743904 | (05) | TX |