=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487682282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEROME SCOTT NOLL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10621 AIRPORT PULLING RD N SUITE 4
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-7333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-592-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10621 AIRPORT ROAD NORTH SUITE 4
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-7333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-592-0700
-----------------------------------------------------
Fax | 239-592-0700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO1811
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------