Provider Demographics
NPI:1386970523
Name:KOCH, JOSEPH ALAN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:KOCH
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 1:10 MEDICAL CENTER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3163
Mailing Address - Country:US
Mailing Address - Phone:936-639-4393
Mailing Address - Fax:877-916-5022
Practice Address - Street 1:10 MEDICAL CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-639-4393
Practice Address - Fax:877-916-5022
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine