Provider Demographics
NPI:1588193379
Name:NOLA, RAMON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:NOLA
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 1:1001 JOHNSON PKWY STE A1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3655
Mailing Address - Country:US
Mailing Address - Phone:651-646-0028
Mailing Address - Fax:651-348-8638
Practice Address - Street 1:1001 JOHNSON PKWY STE A1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3655
Practice Address - Country:US
Practice Address - Phone:651-646-0028
Practice Address - Fax:651-348-8638
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN67976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty