Provider Demographics
NPI:1104857911
Name:GOLLIER, JOHN COOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:COOPER
Last Name:GOLLIER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1418 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3543
Mailing Address - Country:US
Mailing Address - Phone:785-242-1620
Mailing Address - Fax:785-242-3825
Practice Address - Street 1:1418 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3543
Practice Address - Country:US
Practice Address - Phone:785-242-1620
Practice Address - Fax:785-242-3825
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-28601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2924584001OtherCIGNA INDIVIDUAL NUMBER
KS5818702OtherAETNA INDIVIDUAL NUMBER
KS335891OtherHEALTHWAVE
KS058541OtherBLUE CROSS BLUE SHIELD KS
KS26325027OtherBC/BS KANSAS CITY
KS058541Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
KS5818702OtherAETNA INDIVIDUAL NUMBER