Healthcare Provider Details

I. General information

NPI: 1629021696
Provider Name (Legal Business Name): DAVID C. NONELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W
BRADENTON FL
34209-4604
US

IV. Provider business mailing address

8004 11TH AVE NW
BRADENTON FL
34209-9744
US

V. Phone/Fax

Practice location:
  • Phone: 941-798-6303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME37261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: