Provider Demographics
NPI:1568409142
Name:KOCH, ROBERT HERMAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HERMAN
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:516 JACKSON RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-2845
Practice Address - Country:US
Practice Address - Phone:660-882-3585
Practice Address - Fax:660-882-3709
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7E21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2086773801OtherKANSAS MEDICAID
MO202141909Medicaid
MO104107OtherUNITED HEALTHCAE
MO202141909Medicaid
MO2086773801OtherHEALTHLINK
KS2086773801OtherKANSAS MEDICAID
KS2086773801OtherKANSAS MEDICAID