Provider Demographics
NPI:1093929705
Name:NOONAN, THOMAS ADDIS JR (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ADDIS
Last Name:NOONAN
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:546 INDIAN SPRINGS DR.
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-895-5745
Mailing Address - Fax:830-895-5745
Practice Address - Street 1:546 INDIAN SPRINGS DR.
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-895-5745
Practice Address - Fax:830-895-5745
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG21972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19927Medicare UPIN