Individual
EZRA KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4108 39TH AVE NW, MANDAN, ND 58554-1253
(701) 426-4291
Mailing address
4108 39TH AVE NW, MANDAN, ND 58554-1253
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
19404
ND
Other
Enumeration date
06/03/2020
Last updated
03/01/2023
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