Provider Demographics
NPI:1871235614
Name:DANIEL NOEL MD LLC
Entity type:Organization
Organization Name:DANIEL NOEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPPM
Authorized Official - Phone:318-427-3305
Mailing Address - Street 1:221 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:318-443-9773
Mailing Address - Fax:318-427-3306
Practice Address - Street 1:221 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303
Practice Address - Country:US
Practice Address - Phone:318-443-9773
Practice Address - Fax:318-427-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2503626Medicaid