Organization
DEXTER D KOONS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEXTER D KOONS M.D. (OWNER)
(719) 296-6872
Entity
Organization
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 320-3515
(719) 543-1309
Mailing address
PO BOX 8561, PUEBLO, CO 81008-8561
(719) 320-3515
(719) 543-1309
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04013876
—
CO
Enumeration date
04/11/2006
Last updated
11/10/2016
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