Provider Demographics
NPI:1497866149
Name:HANDLOSER, HOLLY (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HANDLOSER
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 1:610 SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6873
Mailing Address - Country:US
Mailing Address - Phone:501-268-6831
Mailing Address - Fax:501-279-2402
Practice Address - Street 1:610 SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6873
Practice Address - Country:US
Practice Address - Phone:501-268-6831
Practice Address - Fax:501-279-2402
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137327001Medicaid
AR137327001Medicaid
AR5L275Medicare ID - Type Unspecified