Provider Demographics
NPI:1851338586
Name:KOLLER, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:101 S FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7637
Practice Address - Country:US
Practice Address - Phone:573-882-4464
Practice Address - Fax:573-884-8142
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO110284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111029OtherBLUE SHIELD/BLUE CHOICE
MO286085OtherHEALTHLLINK
MO409667OtherUNITED HEALTHCARE
MO208291203Medicaid
MOP00415630Medicare UPIN
MO214011444Medicare PIN
MO208291203Medicaid
MO969485236Medicare PIN
MO286085OtherHEALTHLLINK