MEDICARE: JOHN RAYMOND MARNOCHA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	14116-20	WI

General Provider Information

NPI Number	:	1225369630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RAYMOND MARNOCHA MD

Provider Business Mailing Address
First Line	:	3330 CROSSINGS CT
Second Line	:	PH2
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-2686
Country	:	US
Telephone Number	:	239-948-9446
Fax Number	:	239-948-9446

Provider Business Practice Location Address
First Line	:	3330 CROSSINGS CT
Second Line	:	PH2
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-2686
Country	:	US
Telephone Number	:	239-948-9446
Fax Number	:	239-948-9446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/25/2010

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