Healthcare Provider Details

I. General information

NPI: 1093789141
Provider Name (Legal Business Name): WILLIAM BARRY NOLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 CLIFF ST
GRACEVILLE FL
32440-1734
US

IV. Provider business mailing address

5897 HIGHWAY 77
GRACEVILLE FL
32440-4015
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-6321
  • Fax:
Mailing address:
  • Phone: 850-263-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME41316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: