MEDICARE: ROBERT R. NOONEY, DO, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OPO00001277	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700031317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT R. NOONEY, DO, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 11392
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98508-1392
Country	:	US
Telephone Number	:	360-754-2300
Fax Number	:	360-754-1044

Provider Business Practice Location Address
First Line	:	410-A BLACK HILLS LANE SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-2300
Country	:	US
Telephone Number	:	360-754-2300
Fax Number	:	360-754-1044

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. ROBERT ROSCOE NOONEY
Credential	:	D.O.
Telephone Number	:	360-754-2300

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	02/19/2009

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