Provider Demographics
NPI:1023072485
Name:KOERNER, PAUL D (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:KOERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 KELLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242
Mailing Address - Country:US
Mailing Address - Phone:731-664-3522
Mailing Address - Fax:901-922-6767
Practice Address - Street 1:1290 KELLEY DRIVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242
Practice Address - Country:US
Practice Address - Phone:731-664-3522
Practice Address - Fax:901-922-6767
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD317462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702343Medicaid
TN3720631Medicaid
TN3720567Medicaid
TN3837928Medicare ID - Type Unspecified
TN3702343Medicaid
G86646Medicare UPIN
3837929Medicare PIN