Individual
CHARLES THOMAS KOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 W POPLAR ST, WALLA WALLA, WA 99362-2846
(509) 897-3320
Mailing address
PO BOX 32, LIBERTY LAKE, WA 99019-0032
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD61016069
WA
208M00000X
Hospitalist Physician
Primary
MD61016069
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2016
Last updated
02/03/2021
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