MEDICARE: JANET M NOLL M.D.

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	208000000X	Pediatrics Physician	E6147	TX

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
2	1992784177	OTHER	TX	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	890104	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992784177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET M NOLL M.D.

Provider Business Mailing Address
First Line	:	333 N SANTA ROSA ST
Second Line	:	STE D4023
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3108
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-2609

Provider Business Practice Location Address
First Line	:	8366 N LOOP 1604 W
Second Line	:	STE 105
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3533
Country	:	US
Telephone Number	:	210-680-6000
Fax Number	:	210-680-9153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	10/31/2016

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Directions to “ JANET M NOLL M.D.” Practice Location

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