Provider Demographics
NPI:1174985352
Name:KOCH, KRISTOPHER ROBERT (MD,MPH)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:ROBERT
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 NACOGDOCHES RD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1907
Mailing Address - Country:US
Mailing Address - Phone:210-653-8989
Mailing Address - Fax:210-590-4608
Practice Address - Street 1:14100 NACOGDOCHES RD STE 116
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1907
Practice Address - Country:US
Practice Address - Phone:210-653-8989
Practice Address - Fax:210-590-4608
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine