Basic Information
| Provider Information | |||||||||
| NPI: | 1780650812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLAN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 PARKWAY OFFICE COURT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194813338 | ||||||||
| FaxNumber: | 9194672436 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 PARKWAY OFFICE COURT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194813338 | ||||||||
| FaxNumber: | 9194672436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 36.003433 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 36.003433 | OH | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.