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DR. DEREK KOLLER M.D. NPI 1629338470


NPI Information

NPI: 1629338470
Provider Name: DR. DEREK KOLLER, M.D.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
6861 LEMONGRASS LOOP SE
SALEM, OR
ZIP 97306
Phone: (361) 902-4789
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DR. Derek Koller, M.D. is a family medicine in Salem, OR with 12 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Derek Koller, M.D. NPI is 1629338470. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Graduation Year:2012

The provider's business location address is:

6861 LEMONGRASS LOOP SE
SALEM, OR
ZIP 97306-474
Phone: (361) 902-4789
Fax: (361) 902-4588

The NPI 1629338470 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/25/2012 and was last updated on 1/13/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine17981HAWAIIYes
2207Q00000XFamily Medicine036151000ILLINOISNo
3207Q00000XFamily MedicineME142837FLORIDANo
4207Q00000XFamily MedicineS2376TEXASNo
5207Q00000XFamily Medicine55553ARIZONANo
6207Q00000XFamily Medicine11453AWYOMINGNo
7207Q00000XFamily Medicine17828NEVADANo
8207Q00000XFamily MedicineMD2018-0164NEW MEXICONo
9207Q00000XFamily MedicineMD186008OREGONNo
10207Q00000XFamily MedicineMD60818224WASHINGTONNo
11207Q00000XFamily MedicineDR.0059780COLORADONo
12207Q00000XFamily MedicineA143337CALIFORNIANo
13207Q00000XFamily MedicineMED-PHYS-LIC-60886MONTANANo
14207Q00000XFamily MedicineM-14141IDAHONo
15207Q00000XFamily Medicine284778NEW YORKNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.