Provider Demographics
NPI:1073610002
Name:NOBLE, DECARLO (MD)
Entity Type:Individual
Prefix:DR
First Name:DECARLO
Middle Name:
Last Name:NOBLE
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 1:2435 W OAK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4313
Mailing Address - Country:US
Mailing Address - Phone:940-891-3600
Mailing Address - Fax:940-891-3606
Practice Address - Street 1:2435 W OAK ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4313
Practice Address - Country:US
Practice Address - Phone:940-891-3600
Practice Address - Fax:940-891-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5851174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158831101Medicaid
TXH80023Medicare UPIN
TX158831101Medicaid