Organization
JERROL NOLLER MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERROL JAY NOLLER MD (PRESIDENT)
(763) 427-6897
Entity
Organization
Contact information
Practice address
3863 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2518
(763) 433-8300
(763) 433-8308
Mailing address
1416 OAKWOOD DR, ANOKA, MN 55303-2747
(763) 433-8300
(763) 433-8308
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
23068
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
774888400
—
MN
Enumeration date
06/06/2008
Last updated
06/06/2008
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