Healthcare Provider Details

I. General information

NPI: 1497955405
Provider Name (Legal Business Name): JACQUE F. NOEL, III, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD SUITE 400
LAFAYETTE LA
70503-2638
US

IV. Provider business mailing address

1211 COOLIDGE BLVD SUITE 400
LAFAYETTE LA
70503-2638
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-9779
  • Fax: 337-235-0654
Mailing address:
  • Phone: 337-235-9779
  • Fax: 337-235-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number017730
License Number StateLA

VIII. Authorized Official

Name: MR. JACQUE F NOEL III
Title or Position: GASTROENTEROLGIST
Credential: M.D.
Phone: 337-235-9779