Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G2197 | TX |
NPI | 1093929705 |
---|---|
Provider Name | Dr. Thomas Addis Noonan JR. |
First Address | Kerrville, TX 78028 |
Second Address | Kerrville, TX 78028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 18/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C19927 | (02) | TX |