Individual
DR. MARTIN LEROY KOONSMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
221 W COLORADO BLVD, PAV II, SUITE 532, DALLAS, TX 75208
(214) 943-8605
(214) 946-8339
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
H6352
TX
2086X0206X
Surgical Oncology Physician
Primary
H6352
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020027451
RR-MEDICARE
TX
05
—
097588001
—
TX
05
—
097588003
—
TX
01
—
P01100125
RAILROAD MEDICARE
TX
Enumeration date
06/08/2006
Last updated
04/11/2023
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