Individual
RALPH MAXIMILLIAN KOENKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
180 ROWLAND WAY, NOVATO, CA 94945-5009
(415) 290-1500
Mailing address
PO BOX 6102, NOVATO, CA 94948-6102
(415) 884-3418
(415) 883-8082
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
G60981
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G60981
CA
2085R0204X
Vascular & Interventional Radiology Physician
G60981
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G609810
BLUE SHIELD
CA
05
—
00G609810
—
CA
01
—
300035771
RAILROAD MEDICARE
CA
01
—
300121787
RAILROAD MEDICARE
CA
Enumeration date
06/04/2006
Last updated
03/07/2012
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