Healthcare Provider Details

I. General information

NPI: 1952570418
Provider Name (Legal Business Name): CORY VINCENT NOEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 PIPER ST STE T345
ANCHORAGE AK
99508-4694
US

IV. Provider business mailing address

6621 FANNIN STREET MC 19345-C
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 907-339-1945
  • Fax: 907-339-1994
Mailing address:
  • Phone: 832-826-5635
  • Fax: 832-825-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number147297
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: