Provider Demographics
NPI:1871856757
Name:HOLLWEG, JOHANNA GRACE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:GRACE
Last Name:HOLLWEG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JOHANNA
Other - Middle Name:GRACE HOLLWEG
Other - Last Name:MAROWSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-3647
Mailing Address - Fax:210-916-3195
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:QUALITY SERVICES ATTN: MCHE-ZQQ
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-3647
Practice Address - Fax:210-916-3195
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1138207R00000X, 207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program