Provider Demographics
NPI:1417119603
Name:KOCH, REBEKAH W (MD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:W
Last Name:KOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1105 W FRANK AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-639-4393
Mailing Address - Fax:936-639-0877
Practice Address - Street 1:1105 W FRANK AVE
Practice Address - Street 2:STE 280
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-639-4393
Practice Address - Fax:936-639-0877
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP100314042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry