Healthcare Provider Details

I. General information

NPI: 1821588153
Provider Name (Legal Business Name): DAVID MATTHEW NOBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W FRONT ST STE 100
TRAVERSE CITY MI
49684-2287
US

IV. Provider business mailing address

1215 LEE ST BOX 801016
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-0800
  • Fax:
Mailing address:
  • Phone: 434-243-0270
  • Fax: 434-243-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301511265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: