Healthcare Provider Details

I. General information

NPI: 1023184892
Provider Name (Legal Business Name): NOELLE DUVAL GATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BESSEMER SUPER HIGHWAY
BIRMINGHAM AL
35228
US

IV. Provider business mailing address

PO BOX 2648
BIRMINGHAM AL
35202
US

V. Phone/Fax

Practice location:
  • Phone: 205-715-6121
  • Fax: 205-930-1326
Mailing address:
  • Phone: 205-930-1363
  • Fax: 205-930-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME111181
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23400
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: