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General NPI Number Information
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NPI Number | 1225369630
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Entity Type | Individual
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Provider Name | JOHN RAYMOND MARNOCHA MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 3330 CROSSINGS CT PH2
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-2686
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Country | US
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Telephone | 239-948-9446
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Fax | 239-948-9446
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Provider Business Mailing Address
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Address Line | 3330 CROSSINGS CT PH2
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-2686
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Country | US
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Telephone | 239-948-9446
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Fax | 239-948-9446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 14116-20
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License Number State | WI
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