Provider Demographics
NPI:1366493587
Name:NUESSLE, WILLIAM RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:NUESSLE
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 1:7733 MALLARD RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2852
Mailing Address - Country:US
Mailing Address - Phone:256-426-6323
Mailing Address - Fax:256-533-4937
Practice Address - Street 1:115 MANNING DR SW
Practice Address - Street 2:SUITE D101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4341
Practice Address - Country:US
Practice Address - Phone:256-533-6070
Practice Address - Fax:256-533-9374
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015166208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000082134Medicaid
D26173Medicare UPIN
82134Medicare ID - Type Unspecified