Provider Demographics
NPI:1043235286
Name:KOCH, H. BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:BRUCE
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 1:1984 WOODBINE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9277
Mailing Address - Country:US
Mailing Address - Phone:937-335-2122
Mailing Address - Fax:937-498-4201
Practice Address - Street 1:915 W MICHIGAN
Practice Address - Street 2:WILSON MEMORIAL HOSPITAL EMERGENCY DEPT.
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2491
Practice Address - Country:US
Practice Address - Phone:937-498-5300
Practice Address - Fax:937-498-4201
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058963207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0775899Medicaid
OH0775899Medicaid