Provider Demographics
NPI:1558410969
Name:KOEHLER, JAMES RICHARD (MD DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7541 CIPRIANO CT
Mailing Address - Street 2:FAIRHOPE
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3029
Mailing Address - Country:US
Mailing Address - Phone:251-929-7850
Mailing Address - Fax:251-929-2500
Practice Address - Street 1:7541 CIPRIANO CT
Practice Address - Street 2:FAIRHOPE
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3029
Practice Address - Country:US
Practice Address - Phone:251-929-7850
Practice Address - Fax:251-929-2500
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23701208600000X
AL23669208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery