Provider Demographics
NPI:1063463412
Name:KOCH, ELIZABETH ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ONE BAYLOR PLAZA
Mailing Address - Street 2:ROOM 165B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-4417
Mailing Address - Fax:713-798-8050
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:DEPT OF RADIOLOGY,BCM 360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG14572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L22448Medicare PIN
TX84710RMedicare PIN
86309RMedicare PIN
TXG68326Medicare UPIN