Healthcare Provider Details

I. General information

NPI: 1609829407
Provider Name (Legal Business Name): D E NOBLE MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR 202
STUART FL
34994-2579
US

IV. Provider business mailing address

509 SE RIVERSIDE DR 202
STUART FL
34994-2579
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-9177
  • Fax: 772-223-9823
Mailing address:
  • Phone: 772-287-9177
  • Fax: 772-223-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number22477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: