Provider Demographics
NPI:1720018930
Name:NOEL, GEORGE C (PA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:NOEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6150
Mailing Address - Country:US
Mailing Address - Phone:903-261-7308
Mailing Address - Fax:
Practice Address - Street 1:614 S GROVE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5219
Practice Address - Country:US
Practice Address - Phone:903-927-6240
Practice Address - Fax:903-934-5365
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 00205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S56616Medicare UPIN
8E0604Medicare ID - Type Unspecified