Basic Information
| Provider Information | |||||||||
| NPI: | 1194162883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEPPEL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MARKUS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 657 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DEMOREST | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305350657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607233915 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 225 CLARKSON RD | ||||||||
| Address2: | |||||||||
| City: | ELLISVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068654001 | ||||||||
| FaxNumber: | 7068656268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 076204 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2022017094 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.