MEDICARE: WILLIAM BARRY NOLIN M.D.

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	207Q00000X	Family Medicine Physician	ME41316	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00060601	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	32065	OTHER	FL	BLUE CROSS
3	59082385	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1093789141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BARRY NOLIN M.D.

Provider Business Mailing Address
First Line	:	5897 HIGHWAY 77
Second Line	:
City	:	GRACEVILLE
State	:	FL
Zip	:	32440-4015
Country	:	US
Telephone Number	:	850-263-6905
Fax Number	:

Provider Business Practice Location Address
First Line	:	5422 CLIFF ST
Second Line	:
City	:	GRACEVILLE
State	:	FL
Zip	:	32440-1734
Country	:	US
Telephone Number	:	850-263-6321
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/09/2007

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