Provider Demographics
NPI:1770571903
Name:NOBLE, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:NOBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2500 MILVIA ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2636
Mailing Address - Country:US
Mailing Address - Phone:510-848-7070
Mailing Address - Fax:510-848-5500
Practice Address - Street 1:2500 MILVIA ST
Practice Address - Street 2:SUITE 218
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2636
Practice Address - Country:US
Practice Address - Phone:510-848-7070
Practice Address - Fax:510-848-5500
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG17043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942707753OtherFEDERAL TIN
CAA89267Medicare UPIN
CA00G170430Medicare ID - Type Unspecified