Individual
DEXTER D KOONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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 81008-8516
(719) 320-3515
(719) 543-1309
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
28413
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01284132
—
CO
Enumeration date
07/26/2005
Last updated
11/09/2016
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