Basic Information
| Provider Information | |||||||||
| NPI: | 1619364015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 SUTTLE ST | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813038276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703352232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 691 E EMPIRE ST | ||||||||
| Address2: | |||||||||
| City: | CORTEZ | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813212802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705657946 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0059543 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | BP10052470 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.