Individual
DR. RICHARD BRUCE KOEFOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 N ALPHA ST, GRAND ISLAND, NE 68803-4316
(308) 381-0473
(308) 381-2616
Mailing address
620 N ALPHA ST, GRAND ISLAND, NE 68803-4316
(308) 381-0473
(308) 381-2616
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18143
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00378
BLUE CROSS
NE
01
—
247460
MIDLANDS CHOICE
NE
01
—
P00241093
RAILROAD MEDICARE
NE
Enumeration date
01/18/2006
Last updated
01/28/2010
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