Provider Demographics
NPI:1013255991
Name:NOBLE, CARL (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:NOBLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 IRVING ST NW APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3077
Mailing Address - Country:US
Mailing Address - Phone:141-998-9072
Mailing Address - Fax:
Practice Address - Street 1:1400 DRY CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6499
Practice Address - Country:US
Practice Address - Phone:303-772-3300
Practice Address - Fax:303-682-3380
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116025257207R00000X
OH34013830207W00000X
390200000X
CO0066315207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO274553Medicaid