Individual
BRENTON B KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4855 MILLS CIVIC PKWY # 100, WEST DES MOINES, IA 50265-5268
(515) 277-5555
(515) 277-0060
Mailing address
4855 MILLS CIVIC PKWY # 100, WEST DES MOINES, IA 50265-5268
(515) 277-5555
(515) 277-0060
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
31968
IA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
31968
IA
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
31968
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1162586
—
IA
Enumeration date
07/07/2005
Last updated
03/11/2014
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