Provider Demographics
NPI:1730440314
Name:GONZALES-TOLLY, DORA ISABEL (DO)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:ISABEL
Last Name:GONZALES-TOLLY
Suffix:
Gender:F
Credentials:DO
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 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:784 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3983
Practice Address - Country:US
Practice Address - Phone:740-654-4942
Practice Address - Fax:740-654-4939
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAP2282058A17207Q00000X
OH34012281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine