Provider Demographics
NPI:1255782843
Name:KOEHLER, SETH TYLER (DO)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:TYLER
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2600 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2473
Mailing Address - Country:US
Mailing Address - Phone:573-755-2310
Mailing Address - Fax:573-519-4675
Practice Address - Street 1:2600 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2473
Practice Address - Country:US
Practice Address - Phone:573-755-2310
Practice Address - Fax:573-519-4675
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018007982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine