Individual
DR. THOMAS J. KOONTZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2915 LYNDHURST AVE, WINSTON-SALEM, NC 27103-4005
(336) 765-5221
(336) 765-0430
Mailing address
4250 ALLISTAIR RD, WINSTON-SALEM, NC 27104-1204
(336) 768-0196
(336) 765-0430
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
15108
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15108
NC LICENSE
NC
05
—
8950063
—
NC
Enumeration date
03/22/2006
Last updated
03/07/2023
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