Provider Demographics
NPI:1336108224
Name:NOEL, J ROBERT III (OPAC)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:ROBERT
Last Name:NOEL
Suffix:III
Gender:M
Credentials:OPAC
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:FAIRVIEW GERIATRIC SERVICES
Practice Address - Street 2:7505 METRO BLVD SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:651-247-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-08-31
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Provider Licenses
StateLicense IDTaxonomies
MN8842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN751119100Medicaid