MEDICARE: MR. WILLIAM JOHN NUMMY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	3326762	FL

General Provider Information

NPI Number	:	1972570406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JOHN NUMMY CRNA

Provider Business Mailing Address
First Line	:	3034 SELMA AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5843
Country	:	US
Telephone Number	:	850-914-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	3034 SELMA AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5843
Country	:	US
Telephone Number	:	850-914-0010
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	12/27/2007

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Directions to “ MR. WILLIAM JOHN NUMMY CRNA” Practice Location

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