Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | OS13347 | FL |
NPI | 1073749644 |
---|---|
Provider Name | Dr. Noah Ridings Converse |
First Address | Fort Walton Beach, FL 32547-6663 |
Second Address | Fort Walton Beach, FL 32547-6663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 27/01/2022 |