Provider Demographics
NPI:1073586087
Name:NOORDA, J CAL (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:CAL
Last Name:NOORDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1302 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-657-9555
Practice Address - Fax:702-657-9040
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV6278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073586087Medicaid
NV1073586087Medicaid
NVF06862Medicare UPIN
NV2019155Medicaid
NVWJBKN10Medicare PIN