Provider Demographics
NPI:1275576902
Name:NOON, SANDRA K (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:K
Last Name:NOON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:ADULT MEDICINE CLINIC
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6641
Mailing Address - Fax:808-433-1556
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:ADULT MEDICINE CLINIC
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6641
Practice Address - Fax:808-433-1556
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012028207R00000X
HIDOS-1160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1153301564OtherBCBS/BCN
MI4487147Medicaid
MI1008361OtherMCLAREN HEALTH ADVANTAGE
MI04-70145OtherPHP FAMILYCARE
MIP00008134OtherRAILROAD MEDICARE
MI04-00145OtherPHP
MI1008361OtherMCLAREN HEALTH PLAN
MI4835429Medicaid
MI5291514OtherAETNA
MI04-00145OtherPHP
MIP00008134OtherRAILROAD MEDICARE