Provider Demographics
NPI:1750325601
Name:KOCH, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
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 1:200 E SAN AUGUSTINE ST UNIT 130
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4191
Mailing Address - Country:US
Mailing Address - Phone:281-784-9223
Mailing Address - Fax:281-715-1802
Practice Address - Street 1:200 E SAN AUGUSTINE ST UNIT 130
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4191
Practice Address - Country:US
Practice Address - Phone:281-784-9223
Practice Address - Fax:281-715-1802
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89Y447OtherBCBS
TX138278004Medicaid
TX89Y441Medicare PIN
TX138278004Medicaid
TXD88966Medicare UPIN