Provider Demographics
NPI:1609983345
Name:KOON, JAMES E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:KOON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:635 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4129
Mailing Address - Country:US
Mailing Address - Phone:863-294-0670
Mailing Address - Fax:863-298-3200
Practice Address - Street 1:635 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4129
Practice Address - Country:US
Practice Address - Phone:863-294-0670
Practice Address - Fax:863-298-3200
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2691213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL131864001OtherDME PALMETTO PROVIDER #
FL480028215OtherRAILROAD MEDICARE PROVIDE
FLK0339OtherMEDICARE GROUP #
FL1043321763OtherGROUP NPI
FL65576OtherBC BS PROVIDER
FL1609983345OtherINDIV NPI
FLU70521Medicare UPIN
FL1609983345OtherINDIV NPI