Healthcare Provider Details

I. General information

NPI: 1942287669
Provider Name (Legal Business Name): BRENDAN MICHAEL NOONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MEDICAL GROUP / KADENA AIR BASE, JAPAN FLIGHT MEDICINE CLINIC
APO AP
96368
US

IV. Provider business mailing address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

V. Phone/Fax

Practice location:
  • Phone: 011816117304305
  • Fax:
Mailing address:
  • Phone: 850-883-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3685
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: