Basic Information
| Provider Information | |||||||||
| NPI: | 1073749644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONVERSE | ||||||||
| FirstName: | NOAH | ||||||||
| MiddleName: | RIDINGS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1032 MAR WALT DR UNIT 250 | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508633463 | ||||||||
| FaxNumber: | 8503156051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1032 MAR WALT DR UNIT 250 | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508633463 | ||||||||
| FaxNumber: | 8503156051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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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 | 207T00000X | OS13347 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.