Healthcare Provider Details

I. General information

NPI: 1811099609
Provider Name (Legal Business Name): JAMESON B NOORDA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 N PECOS RD SUITE A
HENDERSON NV
89074-7339
US

IV. Provider business mailing address

68 N PECOS RD SUITE A
HENDERSON NV
89074-7339
US

V. Phone/Fax

Practice location:
  • Phone: 702-456-1441
  • Fax: 702-456-3901
Mailing address:
  • Phone: 702-456-1441
  • Fax: 702-456-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0505
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0505
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0505
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: