Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 46597 | MN |
Y | 207QS0010X | Family Doctor - Sports Medicine | 46597 | MN |
NPI | 1154358273 |
---|---|
Provider Name | John Alexander Noll |
First Address | Bloomington, MN 55425-4516 |
Second Address | Bloomington, MN 55431-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 20/05/2021 |