Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 12608 | TX |
NPI | 1063522357 |
---|---|
Provider Name | Dr. Raymond Reagon Noble SR. |
First Address | San Angelo, TX 76904-5298 |
Second Address | San Angelo, TX 76904-5298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |