Provider Demographics
NPI:1184984155
Name:GONZALES, HOLLY JO (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:55 W SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1825
Practice Address - Country:US
Practice Address - Phone:479-442-6266
Practice Address - Fax:479-521-3877
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2024-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR31152085R0202X
ARE-87512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology