Basic Information
| Provider Information | |||||||||
| NPI: | 1528472495 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KOEHLER | ||||||||
| FirstName: | LOGAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 BRYANT WILLIAMS DR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412742700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5005 N PIEDRAS ST | ||||||||
| Address2: | WILLIAM BEAUMONT ARMY MEDICAL CENTER /ORTHOPAEDIC | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157422288 | ||||||||
| FaxNumber: | 9157421931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD198429 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | MD198429 | OR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.