Provider Demographics
NPI:1033156187
Name:KOCH, CHRISTIAN ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ALBERT
Last Name:KOCH
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:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1004
Mailing Address - Fax:904-633-0022
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19246207RE0101X
PAMD469053207RE0101X
FLME142358207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06936861Medicaid
MSP01236774OtherRAILROAD MEDICARE PTAN
MSP00836334Medicare PIN
MS302I467188Medicare PIN
MSP01236774OtherRAILROAD MEDICARE PTAN
MS06936861Medicaid
MS110001975Medicare PIN