Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 32585 | NE |
NPI | 1609295369 |
---|---|
Provider Name | Ryan Koehler |
First Address | Omaha, NE 68114-8774 |
Second Address | Omaha, NE 68114-8774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 02/04/2021 |