Provider Demographics
NPI:1740209014
Name:NOON, BRADLEY ROY (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROY
Last Name:NOON
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 1:1225 E LATHAM AVE
Mailing Address - Street 2:STE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4423
Mailing Address - Country:US
Mailing Address - Phone:951-652-8700
Mailing Address - Fax:951-766-9944
Practice Address - Street 1:1225 E LATHAM AVE
Practice Address - Street 2:STE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4423
Practice Address - Country:US
Practice Address - Phone:951-652-8700
Practice Address - Fax:951-766-9944
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAH62948207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA017732OtherBLUE CROSS BLUE SHIELD
GA000962794AMedicaid
GA20BBFNFMedicare PIN
GA017732OtherBLUE CROSS BLUE SHIELD