Provider Demographics
NPI:1467463893
Name:NOLAN, CHARLES RAYMOND III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:NOLAN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1215 E COURT ST
Mailing Address - Street 2:GUADALUPE REGIONAL HOSPICE SERVICES
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5129
Mailing Address - Country:US
Mailing Address - Phone:830-401-7561
Mailing Address - Fax:830-379-4441
Practice Address - Street 1:1215 EAST COURT STREET
Practice Address - Street 2:GUADALUPE REGIONAL MEDICAL CENTER
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-401-7561
Practice Address - Fax:830-379-4441
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-08-29
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Provider Licenses
StateLicense IDTaxonomies
TXJ3175207RH0002X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046605404Medicaid
TX046605404Medicaid