Basic Information
| Provider Information | |||||||||
| NPI: | 1003922931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOE | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 INWOOD RD | ||||||||
| Address2: | OUTPATIENT BUILDING WA 7.5 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146458450 | ||||||||
| FaxNumber: | 2146458451 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 INWOOD RD | ||||||||
| Address2: | OUTPATIENT BUILDING WA 7.5 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753909189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146458450 | ||||||||
| FaxNumber: | 2146458451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | G8318 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | D8318 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | G8318 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1226334-01 | 05 | TX | MEDICAID |