Healthcare Provider Details

I. General information

NPI: 1366493587
Provider Name (Legal Business Name): WILLIAM RAYMOND NUESSLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/04/2022
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MANNING DR SW SUITE D101
HUNTSVILLE AL
35801-4341
US

IV. Provider business mailing address

7733 MALLARD RD SW
HUNTSVILLE AL
35802-2852
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-6070
  • Fax: 256-533-9374
Mailing address:
  • Phone: 256-426-6323
  • Fax: 256-533-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number00015166
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: