Provider Demographics
NPI:1124124540
Name:KOEHNE, WILLIAM G (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:KOEHNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E ROMIE LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4209
Mailing Address - Country:US
Mailing Address - Phone:831-422-9001
Mailing Address - Fax:831-422-0577
Practice Address - Street 1:610 E ROMIE LN
Practice Address - Street 2:SUITE 2
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4209
Practice Address - Country:US
Practice Address - Phone:831-422-9001
Practice Address - Fax:831-422-0577
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-41429Medicare UPIN