Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 16737 | KY |
NPI | 1326136789 |
---|---|
Provider Name | Dr. Ronald M Koff |
First Address | New Castle, KY 40050 |
Second Address | New Castle, KY 40050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000047169 | ANTHEM (01) | KY |
1049483 | PASSPORT (01) | KY |
64167372 | (05) | KY |
C69217 | (02) |