# DR. DEREK KOLLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1629338470
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 036151000 | IL | — |
| 207Q00000X | Family Medicine Physician | 11453A | WY | — |
| 207Q00000X | Family Medicine Physician | 17828 | NV | — |
| 207Q00000X | Family Medicine Physician | 17981 | HI | Yes |
| 207Q00000X | Family Medicine Physician | 284778 | NY | — |
| 207Q00000X | Family Medicine Physician | 55553 | AZ | — |
| 207Q00000X | Family Medicine Physician | A143337 | CA | — |
| 207Q00000X | Family Medicine Physician | DR.0059780 | CO | — |
| 207Q00000X | Family Medicine Physician | M-14141 | ID | — |
| 207Q00000X | Family Medicine Physician | MD186008 | OR | — |
| 207Q00000X | Family Medicine Physician | MD2018-0164 | NM | — |
| 207Q00000X | Family Medicine Physician | MD60818224 | WA | — |
| 207Q00000X | Family Medicine Physician | ME142837 | FL | — |
| 207Q00000X | Family Medicine Physician | MED-PHYS-LIC-60886 | MT | — |
| 207Q00000X | Family Medicine Physician | S2376 | TX | — |

## Other

- **Enumeration date:** 05/25/2012
- **Last updated:** 01/13/2020