Basic Information
| Provider Information | |||||||||
| NPI: | 1831465566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEHLER | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 S LANCASTER RD | ||||||||
| Address2: | #181 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752164555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694884600 | ||||||||
| FaxNumber: | 4694884601 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 S LANCASTER RD | ||||||||
| Address2: | #181 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752164555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694884600 | ||||||||
| FaxNumber: | 4694884601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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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 | 208000000X | Q5681 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.