Provider Demographics
NPI:1245455377
Name:KOCH, ROBERT F (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:KOCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:FARRAR-KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4211 VAN DYKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8005
Mailing Address - Country:US
Mailing Address - Phone:813-321-6237
Mailing Address - Fax:813-463-1801
Practice Address - Street 1:4211 VAN DYKE RD STE 200
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-321-6237
Practice Address - Fax:813-463-1801
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9904207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL953ZMedicaid
FLAL953YMedicare PIN
FLAL953ZMedicaid