Individual
KELLY LEE KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
120 E HARRIS AVE, SAN ANGELO, TX 76903-5904
(325) 658-1511
(325) 481-2166
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
(325) 481-2166
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q0294
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8EN017
BCBS
—
Enumeration date
05/06/2010
Last updated
01/09/2015
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