Provider Demographics
NPI:1053389858
Name:KOEPKE, RONALD PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:KOEPKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:2516 BROADMOOR BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2988
Practice Address - Country:US
Practice Address - Phone:318-322-1161
Practice Address - Fax:318-322-9313
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012929207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA100471OtherVANTAGE HEALTH PLAN, INC
LA1191469Medicaid
LA012929OtherLOUISIANA GROUP
LA1191469Medicaid
LA5666582OtherAETNA
LA100471OtherVANTAGE HEALTH PLAN, INC