Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | OS13810 | FL |
N | 207X00000X | Orthopaedic Surgeon | OT014290 | PA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 39926 | SC |
NPI | 1093004350 |
---|---|
Provider Name | Tyler Scott Noble |
First Address | Conway, SC 29526 |
Second Address | Temple Terrace, FL 33637-0925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017374400 | (05) | FL |
399269 | (05) | SC |
OT014290 | LICENSE NO (01) | PA |
S4WBP | BCBS (01) | FL |