Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | E-1871 | AR |
NPI | 1063403913 |
---|---|
Provider Name | Noel M Medel |
First Address | Little Rock, AR 72222-7930 |
Second Address | Little Rock, AR 72205-6221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 04/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134646001 | (05) | AR |
5K849 | BLUE CROSS BLUE SHIELD (01) | AR |
G75323 | (02) |