Provider Demographics
NPI:1801894738
Name:KOENIG, ALBERT SAMUEL III (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:SAMUEL
Last Name:KOENIG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4164
Mailing Address - Country:US
Mailing Address - Phone:479-782-4000
Mailing Address - Fax:479-782-0267
Practice Address - Street 1:2420 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4164
Practice Address - Country:US
Practice Address - Phone:479-782-4000
Practice Address - Fax:479-782-0267
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4336207Q00000X, 207ZP0102X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52965OtherBLUE CROSS BLUE SHIELD ID
ARC68639Medicare UPIN
AR52965Medicare PIN