Provider Demographics
NPI:1972709814
Name:BOLGER, HOLLY-MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY-MARIE
Middle Name:
Last Name:BOLGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HOLLY-MARIE
Other - Middle Name:
Other - Last Name:DUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-7072
Mailing Address - Fax:319-384-8620
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-7072
Practice Address - Fax:319-384-8620
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007017234207V00000X
IADO-04169207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200487060AMedicaid
MO1972709814Medicaid
AR216200003Medicaid