Provider Demographics
NPI:1881683233
Name:KOCH, DOUGLAS D (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4771
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4771
Mailing Address - Country:US
Mailing Address - Phone:713-798-6100
Mailing Address - Fax:713-798-4231
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1501
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-798-6100
Practice Address - Fax:713-798-4231
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF1717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134599303Medicaid
TX134599302Medicaid
TX2317988OtherBLUE LINK
TX82W921OtherBC/BS