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General NPI Number Information
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NPI Number | 1598090888
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Entity Type | Individual
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Provider Name | MICHAEL JOHN NOONAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 95-A W. 1ST AVE. RIO GRANDE MEDICAL CENTER
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City | MONTE VISTA
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State | CO
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Zip | 81144
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Country | US
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Telephone | 719-852-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 223 STALLO ST
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City | MONTE VISTA
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State | CO
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Zip | 81144-1645
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Country | US
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Telephone | 719-850-0613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PAL-2886
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License Number State | CO
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