Individual
JOHN J NASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-8460
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
50889
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100016598
—
WI
01
—
P00983448
RAILROAD MEDICARE
WI
Enumeration date
11/02/2006
Last updated
12/15/2020
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