Provider Demographics
NPI:1184795163
Name:GOLLE, MARIO FLORES JR (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:FLORES
Last Name:GOLLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:WRAMC, 6900 GEORGIA AVE, NW
Mailing Address - Street 2:BLDG 1, RM A330,
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307
Mailing Address - Country:US
Mailing Address - Phone:202-782-7364
Mailing Address - Fax:202-782-4823
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:BLDG 1, RM A330, WRAMC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-7364
Practice Address - Fax:202-782-4823
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine