Provider Demographics
NPI:1386684603
Name:KOCH, RYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RODGERS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7434
Mailing Address - Country:US
Mailing Address - Phone:501-278-3297
Mailing Address - Fax:
Practice Address - Street 1:3130 E RACE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4867
Practice Address - Country:US
Practice Address - Phone:501-380-4870
Practice Address - Fax:501-380-4883
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4715207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162421001Medicaid
AR162421001Medicaid
I61416Medicare UPIN