Provider Demographics
NPI:1871806166
Name:KOEPPE, PATSY RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:PATSY
Middle Name:RUTH
Last Name:KOEPPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SKYLINE RIDGE LOOKOUT
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6041
Mailing Address - Country:US
Mailing Address - Phone:512-847-1673
Mailing Address - Fax:
Practice Address - Street 1:1101 SKYLINE RIDGE LOOKOUT
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6041
Practice Address - Country:US
Practice Address - Phone:512-847-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB-24050Medicare UPIN