Provider Demographics
NPI:1477968212
Name:KO, EDDIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CASSELL DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3747
Mailing Address - Country:US
Mailing Address - Phone:423-245-9600
Mailing Address - Fax:
Practice Address - Street 1:201 CASSELL DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3747
Practice Address - Country:US
Practice Address - Phone:423-245-9600
Practice Address - Fax:423-245-9631
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2017-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program