Provider Demographics
NPI:1780679324
Name:NOBLE, ROBERT P (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:NOBLE
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3318
Mailing Address - Country:US
Mailing Address - Phone:573-778-4513
Mailing Address - Fax:573-778-4506
Practice Address - Street 1:16219 BAXTER RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4777
Practice Address - Country:US
Practice Address - Phone:636-536-0554
Practice Address - Fax:636-778-9236
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51508231H00000X
MO2008020593237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN