Provider Demographics
NPI:1982833646
Name:KOICKEL, BETSY (MD)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:KOICKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4057 RILEY FUZZEL RD STE 1100B
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4632
Mailing Address - Country:US
Mailing Address - Phone:281-907-4863
Mailing Address - Fax:
Practice Address - Street 1:4057 RILEY FUZZEL RD STE 1100B
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4632
Practice Address - Country:US
Practice Address - Phone:281-907-4863
Practice Address - Fax:929-210-6551
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266737207Q00000X
TXT8249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine