Healthcare Provider Details

I. General information

NPI: 1700955390
Provider Name (Legal Business Name): ELISABETH L NOELKE MD, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 KNICKERBOCKER RD
SAN ANGELO TX
76904-7610
US

IV. Provider business mailing address

223 S ABE ST
SAN ANGELO TX
76903-6305
US

V. Phone/Fax

Practice location:
  • Phone: 325-947-6960
  • Fax: 800-809-9641
Mailing address:
  • Phone: 325-212-9236
  • Fax: 800-809-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ0164
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ0164
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: