Individual
PAUL WILLIAM KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 E PRIMROSE ST STE 550, SPRINGFIELD, MO 65807-5180
(417) 269-4647
Mailing address
1000 E PRIMROSE ST STE 300, SPRINGFIELD, MO 65807-5178
(417) 269-4646
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2002028070
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159012
BLUECROSS BLUESHIELD
MO
Enumeration date
11/07/2006
Last updated
07/09/2007
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