Basic Information
| Provider Information | |||||||||
| NPI: | 1528102647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 172 BRUSHY POINTE OVERLOOK | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052697578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33700 HWY 43 | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367843555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346364431 | ||||||||
| FaxNumber: | 3346366129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 06/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO-322 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.