Provider Demographics
NPI:1407285307
Name:CARRASCO, NOEL JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:JOHN M
Last Name:CARRASCO
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:PO BOX 6657
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-6657
Mailing Address - Country:US
Mailing Address - Phone:928-301-4646
Mailing Address - Fax:
Practice Address - Street 1:6540 E REDMONT DR
Practice Address - Street 2:#14
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1088
Practice Address - Country:US
Practice Address - Phone:928-301-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33094208000000X, 2080N0001X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice