Provider Demographics
NPI:1043247513
Name:KOEHLER, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:KOEHLER
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL102532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010714Medicaid
AL051505965OtherBLUE CROSS
AL051505965Medicaid
AL000010717OtherBLUE CROSS
AL009909415Medicaid
AL051512216OtherBLUE CROSS
AL300032378OtherRAILROAD MEDICARE
AL010033CC76178OtherSECTION 1011
ALC76178OtherVIVA
AL009936804Medicaid
AL051510728OtherBLUE CROSS
MS00124502OtherMISSISSIPPI MEDICAID
MS00124502OtherMISSISSIPPI MEDICAID
AL000010714Medicaid
ALC76178OtherVIVA