Provider Demographics
NPI:1023184892
Name:GATES, NOELLE DUVAL (MD)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:DUVAL
Last Name:GATES
Suffix:
Gender:F
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:PO BOX 2648
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202
Mailing Address - Country:US
Mailing Address - Phone:205-930-1363
Mailing Address - Fax:205-930-1326
Practice Address - Street 1:631 BESSEMER SUPER HIGHWAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35228
Practice Address - Country:US
Practice Address - Phone:205-715-6121
Practice Address - Fax:205-930-1326
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111181208000000X
AL23400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009988105Medicaid
AL244009Medicaid
FL007983500Medicaid
AL512-35515OtherBCBS LOCATION ID#
AL051527788OtherBCBS