Active NPI
Bruce Eric Koehler II, MD
- Pediatrics Physician
- Dallas, TX
National Provider Identifier
1831465566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- Q5681
- Practice address
- 3200 S Lancaster Rd
#181
Dallas, TX 75216-4555 - Phone
- (469) 488-4600
- Fax
- (469) 488-4601
- NPI assigned
- Mar 27, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | Q5681 | TX | Primary |
Addresses
Primary practice location
3200 S Lancaster Rd
#181
Dallas, TX 75216-4555
Mailing address
3200 S Lancaster Rd
#181
Dallas, TX 75216-4555
Phone (469) 488-4600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Q5681 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442275200000",
"number": "1831465566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 S LANCASTER RD",
"address_2": "#181",
"city": "DALLAS",
"state": "TX",
"postal_code": "752164555",
"telephone_number": "469-488-4600",
"fax_number": "469-488-4601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 S LANCASTER RD",
"address_2": "#181",
"city": "DALLAS",
"state": "TX",
"postal_code": "752164555",
"telephone_number": "469-488-4600",
"fax_number": "469-488-4601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEHLER",
"first_name": "BRUCE",
"middle_name": "ERIC",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-27",
"last_updated": "2015-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "Q5681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.