Provider Demographics
NPI:1811976566
Name:KOEHLER, DUANE GERARD (DO)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:GERARD
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 B ST SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6808
Mailing Address - Country:US
Mailing Address - Phone:918-542-5551
Mailing Address - Fax:918-542-1555
Practice Address - Street 1:30 B ST SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6808
Practice Address - Country:US
Practice Address - Phone:918-542-5551
Practice Address - Fax:918-542-1555
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2956207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100080320BMedicaid
OK100724930FMedicaid
OK100080320CMedicaid
OK100080320AMedicaid
OK100699440MMedicaid
OK248526901Medicare PIN
OK100699440MMedicaid
OKCR1165Medicare PIN
$$$$$$$$$PMedicare PIN
E82493Medicare UPIN
OK100724930FMedicaid
OK080084711Medicare PIN