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General NPI Number Information
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NPI Number | 1588721195
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Entity Type | Individual
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Provider Name | JOHN M KOLLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 202 CENTER AVE. STE. 102
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City | KODIAK
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State | AK
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Zip | 99615-1126
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Country | US
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Telephone | 907-486-6188
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Fax | 907-486-6146
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Provider Business Mailing Address
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Address Line | PO BOX 1126
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City | KODIAK
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State | AK
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Zip | 99615-1126
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Country | US
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Telephone | 907-486-6188
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Fax | 907-486-6146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3737
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S3737
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License Number State | AK
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