Provider Demographics
NPI:1255549507
Name:JOLLY, DARA (MD)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1412 SW 43RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4803
Mailing Address - Country:US
Mailing Address - Phone:425-271-4910
Mailing Address - Fax:425-264-1041
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:425-271-4910
Practice Address - Fax:425-264-1041
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00048853207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics