Healthcare Provider Details

I. General information

NPI: 1548300056
Provider Name (Legal Business Name): NOEL D CANLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST SUITE G
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

PO BOX 638706
CINCINNATI OH
45263-8706
US

V. Phone/Fax

Practice location:
  • Phone: 270-826-0002
  • Fax: 270-826-0003
Mailing address:
  • Phone: 270-827-7558
  • Fax: 270-827-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number18731
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: