Provider Demographics
NPI:1093789141
Name:NOLIN, WILLIAM BARRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BARRY
Last Name:NOLIN
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 1:5897 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-4015
Mailing Address - Country:US
Mailing Address - Phone:850-263-6905
Mailing Address - Fax:
Practice Address - Street 1:5422 CLIFF ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1734
Practice Address - Country:US
Practice Address - Phone:850-263-6321
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00060601OtherRAILROAD MEDICARE
FL32065OtherBLUE CROSS
AL59082385OtherBLUE CROSS
FL32065OtherBLUE CROSS
AL59082385OtherBLUE CROSS