Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD25797 | OR |
NPI | 1194759670 |
---|---|
Provider Name | Dr. J Noonan |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97330-3771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027887 | (05) | OR |
E77998 | (02) |