MEDICARE: DR. WALLACE RAMSEY NOZILE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	MD600003768	DC
2	207ND0101X	MOHS-Micrographic Surgery Physician	ME139741	FL

General Provider Information

NPI Number	:	1093101107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALLACE RAMSEY NOZILE MD

Provider Business Mailing Address
First Line	:	2505 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4464
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

Provider Business Practice Location Address
First Line	:	4910 MASSACHUSETTS AVE NW STE 308
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4382
Country	:	US
Telephone Number	:	202-695-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2015
Last Update Date	:	03/12/2026

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