Provider Demographics
NPI:1396827010
Name:KOEHLER, TOMMY ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:ROLAND
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:ROLAND
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:43 WOODLORE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2317
Mailing Address - Country:US
Mailing Address - Phone:501-225-0735
Mailing Address - Fax:501-225-0735
Practice Address - Street 1:43 WOODLORE CIRCLE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2317
Practice Address - Country:US
Practice Address - Phone:501-225-0735
Practice Address - Fax:501-225-0735
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC46142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
124245OtherPIN
D84215Medicare UPIN