Provider Demographics
NPI:1457364655
Name:MAYER, NOLAN J (MD)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:J
Last Name:MAYER
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 1:2937 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2915
Mailing Address - Country:US
Mailing Address - Phone:805-648-2763
Mailing Address - Fax:805-628-3601
Practice Address - Street 1:2937 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2915
Practice Address - Country:US
Practice Address - Phone:805-648-2763
Practice Address - Fax:805-628-3601
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69065207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69065OtherSTATE OF CA
CA00F690650Medicaid
WG69065DMedicare ID - Type Unspecified
CAG69065OtherSTATE OF CA