Individual
MR. PETER CHRISTOPHER KOEPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2817 REILLY ST, FORT BRAGG, NC 28310-7324
(910) 396-7775
Mailing address
2817 REILLY ST, FORT BRAGG, NC 28310-7324
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-02309
NC
363AS0400X
Surgical Physician Assistant
PA05201
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186438101
—
TX
01
—
8Y0987
BLUE CROSS
TX
Enumeration date
08/31/2006
Last updated
06/09/2011
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