Provider Demographics
NPI:1134658743
Name:KOCH, CAMERON MANSFIELD (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:MANSFIELD
Last Name:KOCH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:
Practice Address - Street 1:5950 UNIVERSITY AVE STE 145
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8233
Practice Address - Country:US
Practice Address - Phone:515-875-9740
Practice Address - Fax:515-875-9672
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR10888207R00000X
MO20180122792085R0202X
MN732272085R0202X
IAMD-500872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty