Provider Demographics
NPI:1942393053
Name:KOLDER, DANIEL GENE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GENE
Last Name:KOLDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2460 N PONDEROSA DR STE A117
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2468
Mailing Address - Country:US
Mailing Address - Phone:805-484-2855
Mailing Address - Fax:805-389-1245
Practice Address - Street 1:2460 N PONDEROSA DR STE A117
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2468
Practice Address - Country:US
Practice Address - Phone:805-484-2855
Practice Address - Fax:805-389-1245
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT2004016415208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery