Provider Demographics
NPI:1831381805
Name:NOBLE, REX ULYSSES (PA-C)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:ULYSSES
Last Name:NOBLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-324-2800
Mailing Address - Fax:828-294-9162
Practice Address - Street 1:2165 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-324-2800
Practice Address - Fax:828-294-9162
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104281363AS0400X
NC0010-7990363AS0400X
FLPA-910428363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831381805Medicaid
FL00007116OtherFLORIDA PHYSICIAN PRESCRIPTION LICENSE #
FL292935000Medicaid
FLAH599XMedicare PIN