Provider Demographics
NPI:1447233036
Name:NOBLE, JACK COLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:COLE
Last Name:NOBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:355 W HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4441
Practice Address - Country:US
Practice Address - Phone:318-281-4450
Practice Address - Fax:318-281-4464
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA014889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1199346Medicaid
LA5CF47DD24Medicare PIN
LA1199346Medicaid