Provider Demographics
NPI:1366821746
Name:KOON, GARRETT CHASE (DO)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:CHASE
Last Name:KOON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2385
Mailing Address - Country:US
Mailing Address - Phone:270-827-3573
Mailing Address - Fax:270-827-1250
Practice Address - Street 1:2000 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2385
Practice Address - Country:US
Practice Address - Phone:270-827-3573
Practice Address - Fax:270-827-1250
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006228A208000000X
KY04534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics