Ira Joe Kodner, MD

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

31243 Issued in MO

Practice address

1040 N Mason Rd
Ste 120
Saint Louis, MO 63141-6399

Phone

(314) 454-7177

Fax

(314) 454-5249

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1760408983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "C B 8109",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-454-7177",
            "fax_number": "314-747-4871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 N MASON RD",
            "address_2": "STE 120",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416399",
            "telephone_number": "314-454-7177",
            "fax_number": "314-454-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODNER",
        "first_name": "IRA",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MO",
            "license": "31243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0280267039",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014010181",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Divya Kodali, MD
• Kelsie Chizuko Kodama, MD
• Rohan Kodgule, MD
• Shammah Kodjo-Soroh, MD
• Holly Hiroko Kodner, MD
• Asha Kodwani, MD
• Jennifer Anne Koeb, ACNP
• Mary Colleen Koebbe, RN
• Rikki Lynn Koebler, DO
• Jodi Koechner, ARNP

• Colon & Rectal Surgery Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Colon & Rectal Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.