Healthcare Provider Details

I. General information

NPI: 1386631315
Provider Name (Legal Business Name): FRANKLIN G NOLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT MARY PL ANESTHESIA DEPT
SHREVEPORT LA
71101-4343
US

IV. Provider business mailing address

PO BOX 23 MEDICAL CENTER ANESTHESIOLOGISTS
SHREVEPORT LA
71161-0023
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-4440
  • Fax:
Mailing address:
  • Phone: 318-868-3151
  • Fax: 318-861-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number010912
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: