Healthcare Provider Details

I. General information

NPI: 1720026834
Provider Name (Legal Business Name): JOSEPH WYNNE NOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE SUITE #408
PHOENIX AZ
85015-3328
US

IV. Provider business mailing address

5040 N 15TH AVE SUITE #408
PHOENIX AZ
85015-3328
US

V. Phone/Fax

Practice location:
  • Phone: 602-285-0017
  • Fax: 602-285-9986
Mailing address:
  • Phone: 602-285-0017
  • Fax: 602-285-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number14186
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: