Basic Information
| Provider Information | |||||||||
| NPI: | 1043247513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOEHLER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057319701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 19TH STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10253 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000010714 | 05 | AL | MEDICAID | 051505965 | 01 | AL | BLUE CROSS | OTHER | 051505965 | 05 | AL | MEDICAID | 000010717 | 01 | AL | BLUE CROSS | OTHER | 009909415 | 05 | AL | MEDICAID | 051512216 | 01 | AL | BLUE CROSS | OTHER | 300032378 | 01 | AL | RAILROAD MEDICARE | OTHER | 010033CC76178 | 01 | AL | SECTION 1011 | OTHER | C76178 | 01 | AL | VIVA | OTHER | 009936804 | 05 | AL | MEDICAID | 051510728 | 01 | AL | BLUE CROSS | OTHER | 00124502 | 01 | MS | MISSISSIPPI MEDICAID | OTHER |