Provider Demographics
NPI:1497182729
Name:KOCH, ROBERT ARTHUR III (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARTHUR
Last Name:KOCH
Suffix:III
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 1:221 PIIKEA AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:KIHA
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-879-8100
Mailing Address - Fax:808-874-6887
Practice Address - Street 1:221 PIIKEA AVE SUITE A
Practice Address - Street 2:
Practice Address - City:KIHA
Practice Address - State:HI
Practice Address - Zip Code:96753
Practice Address - Country:US
Practice Address - Phone:808-879-8100
Practice Address - Fax:808-874-6887
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLOS13996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017684300Medicaid