Provider Demographics
NPI:1962477414
Name:DIAS, NOEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:G
Last Name:DIAS
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 1:2006 SCENIC DR APT B
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3800
Mailing Address - Country:US
Mailing Address - Phone:602-904-3979
Mailing Address - Fax:
Practice Address - Street 1:2006 SCENIC DR APT B
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3800
Practice Address - Country:US
Practice Address - Phone:602-904-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010149782085R0202X, 207U00000X
KS04329782085R0202X, 207U00000X
NMMD2010-07812085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200311650AMedicaid
P00154641OtherRR MEDICARE GROUP CK7871
MO205693203Medicaid
MO35022012OtherBCBC KANSAS CITY MO
NM55752047Medicaid
205113OtherBCBS KS FOR MO LOCATION
KS111294002Medicare PIN
205113OtherBCBS KS FOR MO LOCATION
NMNMAAA09996Medicare PIN
P00154641OtherRR MEDICARE GROUP CK7871
NMNMAAA0962Medicare PIN