Active NPI
Douglas P Koehn, M.D.
- Family Medicine Physician
- Marshall, MO
National Provider Identifier
1942242003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R2K32
- Practice address
- 2303 S Highway 65
Marshall, MO 65340-3702 - Phone
- (660) 886-3364
- Fax
- (660) 886-6044
- NPI assigned
- Jun 12, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R2K32 | MO | Primary |
Addresses
Primary practice location
2303 S Highway 65
Marshall, MO 65340-3702
Mailing address
PO Box 104240
Jefferson City, MO 65110-4240
Phone (573) 635-5264
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202779401 | Medicaid | MO |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2K32 | MO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418774400000",
"number": "1942242003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 104240",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651104240",
"telephone_number": "573-635-5264",
"fax_number": "573-556-5757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2303 S HIGHWAY 65",
"city": "MARSHALL",
"state": "MO",
"postal_code": "653403702",
"telephone_number": "660-886-3364",
"fax_number": "660-886-6044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEHN",
"first_name": "DOUGLAS",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2014-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R2K32",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202779401",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marshall, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.