Provider Demographics
NPI:1033158407
Name:NOELLERT, RAYMOND C (MD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:C
Last Name:NOELLERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-494-9000
Mailing Address - Fax:
Practice Address - Street 1:4541 N DAVIS HWY STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2733
Practice Address - Country:US
Practice Address - Phone:850-494-9000
Practice Address - Fax:850-474-4123
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106731207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD607YMedicare PIN