Healthcare Provider Details

I. General information

NPI: 1962477414
Provider Name (Legal Business Name): NOEL G DIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 SCENIC DR APT B
ALAMOGORDO NM
88310-3800
US

IV. Provider business mailing address

2006 SCENIC DR APT B
ALAMOGORDO NM
88310-3800
US

V. Phone/Fax

Practice location:
  • Phone: 602-904-3979
  • Fax:
Mailing address:
  • Phone: 602-904-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number2001014978
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number0432978
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD2010-0781
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2001014978
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0432978
License Number StateKS
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2010-0781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: