Provider Demographics
NPI:1922687649
Name:KOON, JOSEPH AARON II
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:AARON
Last Name:KOON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3036
Mailing Address - Country:US
Mailing Address - Phone:501-920-4624
Mailing Address - Fax:
Practice Address - Street 1:819 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3349
Practice Address - Country:US
Practice Address - Phone:501-778-8264
Practice Address - Fax:501-778-7360
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-16850207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine