Provider Demographics
NPI:1225037898
Name:KOERNER, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:KOERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3488
Mailing Address - Country:US
Mailing Address - Phone:936-568-8425
Mailing Address - Fax:936-568-8570
Practice Address - Street 1:1018 N MOUND ST STE 201
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4434
Practice Address - Country:US
Practice Address - Phone:936-560-2763
Practice Address - Fax:936-560-2908
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149490801Medicaid
TX8624J3Medicare ID - Type Unspecified
TXE97783Medicare UPIN