Provider Demographics
NPI:1982656450
Name:NOBLE, JOHN WALLACE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALLACE
Last Name:NOBLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-433-8400
Mailing Address - Fax:337-312-6711
Practice Address - Street 1:1747 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-721-7236
Practice Address - Fax:337-721-7237
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA020895207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA020895OtherSTATE LICENSE NO.
LA1927961Medicaid
LA200040861OtherRR MEDICARE #
TXK9628OtherSTATE LICENSE NO.
LACI9478OtherRR MEDICARE GROUP LEGACY
LA5R007D847OtherMEDICARE LEGACY NUMBER
LA1927961Medicaid
LA020895OtherSTATE LICENSE NO.
LA200040861OtherRR MEDICARE #
LAF28554Medicare UPIN