Provider Demographics
NPI:1811045289
Name:NOONAN, TIMOTHY M (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:NOONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-7500
Mailing Address - Fax:713-512-2234
Practice Address - Street 1:23923 CINCO RANCH BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3399
Practice Address - Country:US
Practice Address - Phone:713-486-7575
Practice Address - Fax:281-769-9942
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8867207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DZ427OtherBLUE CROSS BLUE SHIELD
TX194880402Medicaid
TX613174700OtherDEPARTMENT OF LABOR
TX7857805OtherAETNA
TX613174700OtherDEPARTMENT OF LABOR
TX011948796Medicaid
I15694Medicare UPIN