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Individual
THOMAS KOEHNE
Active
Individual
THOMAS KOEHNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3198
FL
363AS0400X
Surgical Physician Assistant
PA0003198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290428400
—
FL
01
—
970006599
RR MC PROVIDER NUMBER
FL
01
—
972885
P.A.CERTIFICATE NUMBER
FL
01
—
PA0003198
P.A.LICENSE NUMBER
FL
Enumeration date
10/10/2006
Last updated
08/28/2013
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