# JERROL NOLLER MD LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821257593
- **Authorized official:** DR. JERROL JAY NOLLER MD (PRESIDENT)
- **Authorized official phone:** (763) 427-6897

## Contact information

- **Practice address:** 3863 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2518
- **Practice address phone:** (763) 433-8300
- **Practice address fax:** (763) 433-8308
- **Mailing address:** 1416 OAKWOOD DR, ANOKA, MN 55303-2747
- **Mailing address phone:** (763) 433-8300
- **Mailing address fax:** (763) 433-8308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 23068 | MN | Yes |

## Other

- **Enumeration date:** 06/06/2008
- **Last updated:** 06/06/2008