Provider Demographics
NPI:1649432162
Name:HOEFGEN, HOLLY RAE (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:RAE
Last Name:HOEFGEN
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-4211
Mailing Address - Fax:314-747-1481
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV OBGYN PED AND ADOLESCENT GYNECOLOGY, STE 710
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-4211
Practice Address - Fax:314-747-1481
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017039598207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209589506Medicaid