Basic Information
Provider Information
NPI: 1033556212
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOEL
FirstName: GREGORY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 394 S 660 EAST CIR
Address2:  
City: SAINT GEORGE
State: UT
PostalCode: 847703812
CountryCode: US
TelephoneNumber: 7028341196
FaxNumber:  
Practice Location
Address1: 474 W 200 N
Address2:  
City: SAINT GEORGE
State: UT
PostalCode: 847704505
CountryCode: US
TelephoneNumber: 4356345660
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 05/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
247200000X  Y Technologists, Technicians & Other Technical Service ProvidersTechnician, Other 

No ID Information.


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