Provider Demographics
NPI:1588778708
Name:ZOE, HOLLY (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ZOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2404
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2404
Mailing Address - Country:US
Mailing Address - Phone:208-523-7246
Mailing Address - Fax:208-523-9224
Practice Address - Street 1:2060 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6396
Practice Address - Country:US
Practice Address - Phone:208-523-7246
Practice Address - Fax:208-523-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088935207LP2900X
WIPENDING207LP2900X
IDM-9902207LP2900X
IDSPHY-9902208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00472474OtherRAILROAD MEDICARE
P00472474OtherRAILROAD MEDICARE