Mr Leon Koenck, PA C is a medicare enrolled "Physician Assistant" in Gualala, California. His current practice location is
46900 Ocean Dr, Ste 1100, Gualala, California. You can reach out to his office (for appointments etc.) via phone at
(707) 884-4005.
Mr Leon Koenck is licensed to practice in California (license number PA19714) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1164555769.
Provider's Profile
| Full Name | Mr Leon Koenck |
|---|
| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 46900 Ocean Dr, Gualala, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1164555769
- Provider Enumeration Date: 03/13/2007
- Last Update Date: 02/02/2016
Medicare PECOS Information:
- PECOS PAC ID: 8820088800
- Enrollment ID: I20150528001782
Medical Identifiers
Medical identifiers for Mr Leon Koenck such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1164555769 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | 270 (Alaska) | Secondary |
| 363A00000X | Physician Assistant | PA19714 (California) | Primary |
| 363A00000X | Physician Assistant | PA 10003212 (Washington) | Secondary |
| 363AM0700X | Physician Assistant - Medical | PA19714 (California) | Secondary |
| 363AM0700X | Physician Assistant - Medical | PA10003212 (Washington) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Leon Koenck is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Leon Koenck, PA C
200 West 34th Avenue, #539,
Anchorage, AK 99503
Ph: (888) 300-0137 | Mr Leon Koenck, PA C
46900 Ocean Dr, Ste 1100,
Gualala, CA 95445-8353
Ph: (707) 884-4005 |
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