1861485724

Everything you always wanted to know about KOENIG DAVID GARY M.D. but were afraid to ask.

KOENIG DAVID GARY M.D.

You can also download the this 1861485724 data report as csv | excel | json | xml
Provider Last Name Provider Middle Name Provider First Name Provider Credential
KOENIG DAVID GARY M.D.
Gender:
Male
Enumeration date:
2005-08-25
Last update date:
2016-09-02
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state
202823316 Medicaid none MO

Taxonomies

Taxonomy State License Number Primary?
207RG0100X Gastroenterology MO MDR3G44 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 3143554010
Practice Location Address Telephone Number 3143554010
Mailing Address Fax Number 3143559484
Practice Location Address Fax Number 3143559484

Addresses

Type Address City State Postal Country
Mailing Address PO BOX 23340 SAINT LOUIS MO 63156 MO
Practice Location Address 100 VILLAGE SQ HAZELWOOD MO 0 MO

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