Basic Information
| Provider Information | |||||||||
| NPI: | 1407812126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | NOBLE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1901 | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721601901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706737211 | ||||||||
| FaxNumber: | 8706726823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1609 N MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721603274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706737211 | ||||||||
| FaxNumber: | 8706726823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 04/06/2015 | ||||||||
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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 | 207Q00000X | C4808 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103372001 | 05 | AR | MEDICAID | 129734729 | 05 | AR | MEDICAID | 129735729 | 05 | AR | MEDICAID | 203673729 | 05 | AR | MEDICAID | 201477729 | 05 | AR | MEDICAID | 201479729 | 05 | AR | MEDICAID | 201478729 | 05 | AR | MEDICAID | 201481729 | 05 | AR | MEDICAID | 201482729 | 05 | AR | MEDICAID | C4808 | 01 | AR | LICENSE | OTHER | 100907002 | 05 | AR | MEDICAID | 136428729 | 05 | AR | MEDICAID |