Individual
DAVID T KOON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
123 MAIN ST, SUMMERTON, SC 29148
(803) 485-2240
(803) 485-2219
Mailing address
PO BOX 10, 123 MAIN ST, SUMMERTON, SC 29148-0010
(803) 485-2240
(803) 485-2219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19651
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0141069
CAROLINA CARE
SC
05
—
196512
—
SC
01
—
5161
COMPANION
SC
01
—
7161
MEDICARE
SC
01
—
7382016
AETNA
SC
01
—
A7980
MEDCOST
SC
Enumeration date
12/23/2005
Last updated
11/15/2007
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