Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | L5417 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | 55840 | AZ |
N | 2080P0203X | Pediatric Critical Care Doctor | L5417 | TX |
NPI | 1265539969 |
---|---|
Provider Name | Joshua Daniel Koch |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 25/07/2018 |