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Individual
DANIEL ALLEN KOONTZ
Active
Individual
DANIEL ALLEN KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11429
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111796A
—
GA
01
—
060035928
MEDICARE RAILROAD
SC
05
—
114290
—
SC
01
—
570804286
FEDERAL TAX ID
SC
01
—
P01072951
RR MEDICARE
SC
Enumeration date
06/28/2006
Last updated
09/27/2012
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