Healthcare Provider Details

I. General information

NPI: 1750595294
Provider Name (Legal Business Name): RYAN MATTHEW NOBLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BARNES-JEWISH HOSPITAL PLAZA BARNES-JEWISH HOSPITAL
ST. LOUIS MO
63110
US

IV. Provider business mailing address

1776 AMBROSE TERRACE DR
SWANSEA IL
62226-7376
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1242
  • Fax:
Mailing address:
  • Phone: 314-398-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2004014141
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: