Provider Demographics
NPI:1487682282
Name:NOLL, JEROME SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:SCOTT
Last Name:NOLL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 AIRPORT ROAD NORTH
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7333
Mailing Address - Country:US
Mailing Address - Phone:239-592-0700
Mailing Address - Fax:239-592-0700
Practice Address - Street 1:10621 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 4
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7333
Practice Address - Country:US
Practice Address - Phone:239-592-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1811213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
65015Medicare ID - Type Unspecified
T54876Medicare UPIN