Provider Demographics
NPI:1003941634
Name:NOONAN, KEVIN BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BERNARD
Last Name:NOONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1241
Mailing Address - Country:US
Mailing Address - Phone:510-787-1944
Mailing Address - Fax:
Practice Address - Street 1:309 WEST ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1241
Practice Address - Country:US
Practice Address - Phone:510-787-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37792207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services