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Individual
DAVID T KOON JR.
Active
Individual
DAVID T KOON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19651
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0141069
CAROLINA CARE
SC
05
—
196512
—
SC
01
—
5161
COMPANION
SC
01
—
7161
MEDICARE
SC
01
—
7382016
AETNA
SC
01
—
A7980
MEDCOST
SC
Enumeration date
12/23/2005
Last updated
11/15/2007
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