Provider Demographics
NPI:1720026834
Name:NOLAN, JOSEPH WYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WYNNE
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5040 N 15TH AVE
Mailing Address - Street 2:SUITE #408
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3328
Mailing Address - Country:US
Mailing Address - Phone:602-285-0017
Mailing Address - Fax:602-285-9986
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:SUITE #408
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:602-285-0017
Practice Address - Fax:602-285-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14186207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37384Medicare UPIN
ZMD14186Medicare ID - Type Unspecified