Healthcare Provider Details

I. General information

NPI: 1124147467
Provider Name (Legal Business Name): THOMAS EVERETT NOEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MEDICAL DR
TALLAHASSEE FL
32308-4646
US

IV. Provider business mailing address

1300 MEDICAL DR
TALLAHASSEE FL
32308-4646
US

V. Phone/Fax

Practice location:
  • Phone: 850-216-0100
  • Fax: 850-201-4834
Mailing address:
  • Phone: 850-216-0100
  • Fax: 850-201-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME101308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: