Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 26420 | OK |
NPI | 1013177211 |
---|---|
Provider Name | Jamie C Koch |
First Address | Ada, OK 74821-4913 |
Second Address | Ada, OK 74820-4610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 14/06/2012 |