Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0116025257 | VA |
N | 111NI0900X | Internist | 0116025257 | VA |
N | 207W00000X | Ophthalmologist | 34013830 | OH |
Y | 207WX0107X | Retina Specialist | 0066315 | CO |
NPI | 1013255991 |
---|---|
Provider Name | Carl Noble |
First Address | Washington, DC 20010-3077 |
Second Address | Longmont, CO 80503-6499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2013 |
Last Update Date | 17/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274553 | (05) | CO |