# JOHN M KOLLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1588721195
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3737 | AK | — |
| 207Q00000X | Family Medicine Physician | S3737 | AK | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 01/10/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | K151630 | MEDICARE ID ( DEACTIVATED AFTER 5.16.09) | — |
| 01 | — | K162501 | MEDICARE ID 6.29.09 - PRESENT | — |
| 05 | — | MD10072 | — | AK |